|
PLATE POLYAX FEM 8141-30-115
|
Facility
|
OP
|
$11,107.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,332.37 |
| Max. Negotiated Rate |
$10,663.59 |
| Rate for Payer: Aetna Commercial |
$8,553.09
|
| Rate for Payer: Anthem Medicaid |
$3,820.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,664.17
|
| Rate for Payer: Cash Price |
$5,553.96
|
| Rate for Payer: Cigna Commercial |
$9,219.57
|
| Rate for Payer: First Health Commercial |
$10,552.51
|
| Rate for Payer: Humana Commercial |
$9,441.72
|
| Rate for Payer: Humana KY Medicaid |
$3,820.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,858.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,108.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,197.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,332.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,896.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,774.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,330.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,886.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,664.46
|
| Rate for Payer: PHCS Commercial |
$10,663.59
|
| Rate for Payer: United Healthcare All Payer |
$9,774.96
|
|
|
PLATE POLYAX FEM 8141-30-115
|
Facility
|
IP
|
$11,107.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,332.37 |
| Max. Negotiated Rate |
$10,663.59 |
| Rate for Payer: Aetna Commercial |
$8,553.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,664.17
|
| Rate for Payer: Cash Price |
$5,553.96
|
| Rate for Payer: Cigna Commercial |
$9,219.57
|
| Rate for Payer: First Health Commercial |
$10,552.51
|
| Rate for Payer: Humana Commercial |
$9,441.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,108.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,197.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,332.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,774.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,330.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,886.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,664.46
|
| Rate for Payer: PHCS Commercial |
$10,663.59
|
| Rate for Payer: United Healthcare All Payer |
$9,774.96
|
|
|
PLATE POLYAX FEM 8141-30-118
|
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 8141-30-118
|
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 8141-31-106
|
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 8141-31-106
|
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 8141-31-109
|
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 8141-31-109
|
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 8141-31-112
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
PLATE POLYAX FEM 8141-31-112
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| 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: 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE POLYAX FEM 8141-31-118
|
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 8141-31-118
|
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 TIBIAL 11H LT
|
Facility
|
IP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 11H LT
|
Facility
|
OP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem Medicaid |
$3,394.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Humana KY Medicaid |
$3,394.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,428.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,462.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 11H RT
|
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 TIBIAL 11H RT
|
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 TIBIAL 14H LT
|
Facility
|
OP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem Medicaid |
$3,394.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Humana KY Medicaid |
$3,394.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,428.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,462.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 14H LT
|
Facility
|
IP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 2H LT
|
Facility
|
OP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem Medicaid |
$3,394.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Humana KY Medicaid |
$3,394.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,428.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,462.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 2H LT
|
Facility
|
IP
|
$9,869.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.79 |
| Max. Negotiated Rate |
$9,474.53 |
| Rate for Payer: Aetna Commercial |
$7,599.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,698.05
|
| Rate for Payer: Cash Price |
$4,934.65
|
| Rate for Payer: Cigna Commercial |
$8,191.52
|
| Rate for Payer: First Health Commercial |
$9,375.83
|
| Rate for Payer: Humana Commercial |
$8,388.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,092.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,960.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,684.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,401.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,895.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,586.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.82
|
| Rate for Payer: PHCS Commercial |
$9,474.53
|
| Rate for Payer: United Healthcare All Payer |
$8,684.98
|
|
|
PLATE POLYAX TIBIAL 2H RT
|
Facility
|
IP
|
$9,113.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.12 |
| Max. Negotiated Rate |
$8,749.20 |
| Rate for Payer: Aetna Commercial |
$7,017.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.73
|
| Rate for Payer: Cash Price |
$4,556.88
|
| Rate for Payer: Cigna Commercial |
$7,564.41
|
| Rate for Payer: First Health Commercial |
$8,658.06
|
| Rate for Payer: Humana Commercial |
$7,746.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,928.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.49
|
| Rate for Payer: PHCS Commercial |
$8,749.20
|
| Rate for Payer: United Healthcare All Payer |
$8,020.10
|
|
|
PLATE POLYAX TIBIAL 2H RT
|
Facility
|
OP
|
$9,113.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.12 |
| Max. Negotiated Rate |
$8,749.20 |
| Rate for Payer: Aetna Commercial |
$7,017.59
|
| Rate for Payer: Anthem Medicaid |
$3,134.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.73
|
| Rate for Payer: Cash Price |
$4,556.88
|
| Rate for Payer: Cigna Commercial |
$7,564.41
|
| Rate for Payer: First Health Commercial |
$8,658.06
|
| Rate for Payer: Humana Commercial |
$7,746.69
|
| Rate for Payer: Humana KY Medicaid |
$3,134.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,197.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,928.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.49
|
| Rate for Payer: PHCS Commercial |
$8,749.20
|
| Rate for Payer: United Healthcare All Payer |
$8,020.10
|
|
|
PLATE POLYAX TIBIAL 5H LT
|
Facility
|
OP
|
$10,248.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,074.67 |
| Max. Negotiated Rate |
$9,838.94 |
| Rate for Payer: Aetna Commercial |
$7,891.65
|
| Rate for Payer: Anthem Medicaid |
$3,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,994.14
|
| Rate for Payer: Cash Price |
$5,124.45
|
| Rate for Payer: Cigna Commercial |
$8,506.59
|
| Rate for Payer: First Health Commercial |
$9,736.45
|
| Rate for Payer: Humana Commercial |
$8,711.57
|
| Rate for Payer: Humana KY Medicaid |
$3,524.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,560.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,404.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,563.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,074.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,595.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,019.03
|
| Rate for Payer: Ohio Health Group HMO |
$7,686.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,199.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,916.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,071.74
|
| Rate for Payer: PHCS Commercial |
$9,838.94
|
| Rate for Payer: United Healthcare All Payer |
$9,019.03
|
|
