|
PLATE POLARUS 3 STD 14H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 14H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 14H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 18H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 18H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 18H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 18H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 22H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 22H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 22H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 22H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 4H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 4H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 4H R
|
Facility
|
OP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem Medicaid |
$2,522.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Humana KY Medicaid |
$2,522.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,548.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,573.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
PLATE POLARUS 3 STD 4H R
|
Facility
|
IP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
PLATE POLARUS 3 STD 6H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 6H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 6H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 6H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLYAX FEM 8141-30-106
|
Facility
|
IP
|
$7,797.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.38 |
| Max. Negotiated Rate |
$7,486.00 |
| Rate for Payer: Aetna Commercial |
$6,004.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,082.38
|
| Rate for Payer: Cash Price |
$3,898.96
|
| Rate for Payer: Cigna Commercial |
$6,472.27
|
| Rate for Payer: First Health Commercial |
$7,408.02
|
| Rate for Payer: Humana Commercial |
$6,628.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,394.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,754.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,339.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,862.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,848.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,238.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,784.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,380.56
|
| Rate for Payer: PHCS Commercial |
$7,486.00
|
| Rate for Payer: United Healthcare All Payer |
$6,862.17
|
|
|
PLATE POLYAX FEM 8141-30-106
|
Facility
|
OP
|
$7,797.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.38 |
| Max. Negotiated Rate |
$7,486.00 |
| Rate for Payer: Aetna Commercial |
$6,004.40
|
| Rate for Payer: Anthem Medicaid |
$2,681.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,082.38
|
| Rate for Payer: Cash Price |
$3,898.96
|
| Rate for Payer: Cigna Commercial |
$6,472.27
|
| Rate for Payer: First Health Commercial |
$7,408.02
|
| Rate for Payer: Humana Commercial |
$6,628.23
|
| Rate for Payer: Humana KY Medicaid |
$2,681.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,394.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,754.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,339.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,735.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,862.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,848.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,238.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,784.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,380.56
|
| Rate for Payer: PHCS Commercial |
$7,486.00
|
| Rate for Payer: United Healthcare All Payer |
$6,862.17
|
|
|
PLATE POLYAX FEM 8141-30-109
|
Facility
|
IP
|
$9,480.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.17 |
| Max. Negotiated Rate |
$9,101.36 |
| Rate for Payer: Aetna Commercial |
$7,300.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,394.85
|
| Rate for Payer: Cash Price |
$4,740.29
|
| Rate for Payer: Cigna Commercial |
$7,868.88
|
| Rate for Payer: First Health Commercial |
$9,006.55
|
| Rate for Payer: Humana Commercial |
$8,058.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,774.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,996.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,844.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,342.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,110.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,584.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,248.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,541.60
|
| Rate for Payer: PHCS Commercial |
$9,101.36
|
| Rate for Payer: United Healthcare All Payer |
$8,342.91
|
|
|
PLATE POLYAX FEM 8141-30-109
|
Facility
|
OP
|
$9,480.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.17 |
| Max. Negotiated Rate |
$9,101.36 |
| Rate for Payer: Aetna Commercial |
$7,300.05
|
| Rate for Payer: Anthem Medicaid |
$3,260.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,394.85
|
| Rate for Payer: Cash Price |
$4,740.29
|
| Rate for Payer: Cigna Commercial |
$7,868.88
|
| Rate for Payer: First Health Commercial |
$9,006.55
|
| Rate for Payer: Humana Commercial |
$8,058.49
|
| Rate for Payer: Humana KY Medicaid |
$3,260.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,293.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,774.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,996.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,844.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,342.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,110.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,584.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,248.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,541.60
|
| Rate for Payer: PHCS Commercial |
$9,101.36
|
| Rate for Payer: United Healthcare All Payer |
$8,342.91
|
|
|
PLATE POLYAX FEM 8141-30-112
|
Facility
|
IP
|
$9,480.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.17 |
| Max. Negotiated Rate |
$9,101.36 |
| Rate for Payer: Aetna Commercial |
$7,300.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,394.85
|
| Rate for Payer: Cash Price |
$4,740.29
|
| Rate for Payer: Cigna Commercial |
$7,868.88
|
| Rate for Payer: First Health Commercial |
$9,006.55
|
| Rate for Payer: Humana Commercial |
$8,058.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,774.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,996.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,844.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,342.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,110.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,584.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,248.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,541.60
|
| Rate for Payer: PHCS Commercial |
$9,101.36
|
| Rate for Payer: United Healthcare All Payer |
$8,342.91
|
|
|
PLATE POLYAX FEM 8141-30-112
|
Facility
|
OP
|
$9,480.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.17 |
| Max. Negotiated Rate |
$9,101.36 |
| Rate for Payer: Aetna Commercial |
$7,300.05
|
| Rate for Payer: Anthem Medicaid |
$3,260.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,394.85
|
| Rate for Payer: Cash Price |
$4,740.29
|
| Rate for Payer: Cigna Commercial |
$7,868.88
|
| Rate for Payer: First Health Commercial |
$9,006.55
|
| Rate for Payer: Humana Commercial |
$8,058.49
|
| Rate for Payer: Humana KY Medicaid |
$3,260.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,293.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,774.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,996.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,844.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,342.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,110.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,584.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,248.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,541.60
|
| Rate for Payer: PHCS Commercial |
$9,101.36
|
| Rate for Payer: United Healthcare All Payer |
$8,342.91
|
|
