|
PLATE DIST ANTEROLATERAL L 14H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL L 14H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL L 16H
|
Facility
|
OP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Anthem Medicaid |
$2,569.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Humana KY Medicaid |
$2,569.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,621.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATERAL L 16H
|
Facility
|
IP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATERAL R 10H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL R 10H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL R 12H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL R 12H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL R 14H
|
Facility
|
IP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATERAL R 14H
|
Facility
|
OP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Anthem Medicaid |
$2,569.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Humana KY Medicaid |
$2,569.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,621.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATERAL R 16H
|
Facility
|
IP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATERAL R 16H
|
Facility
|
OP
|
$7,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.36 |
| Max. Negotiated Rate |
$7,173.12 |
| Rate for Payer: Aetna Commercial |
$5,753.44
|
| Rate for Payer: Anthem Medicaid |
$2,569.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Cash Price |
$3,736.00
|
| Rate for Payer: Cigna Commercial |
$6,201.76
|
| Rate for Payer: First Health Commercial |
$7,098.40
|
| Rate for Payer: Humana Commercial |
$6,351.20
|
| Rate for Payer: Humana KY Medicaid |
$2,569.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,595.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,127.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,241.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,621.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,575.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,604.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,316.32
|
| Rate for Payer: PHCS Commercial |
$7,173.12
|
| Rate for Payer: United Healthcare All Payer |
$6,575.36
|
|
|
PLATE DIST ANTEROLATRL TIB 8H
|
Facility
|
OP
|
$9,936.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.74 |
| Max. Negotiated Rate |
$9,538.98 |
| Rate for Payer: Anthem Medicaid |
$3,417.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,750.42
|
| Rate for Payer: Cash Price |
$4,968.22
|
| Rate for Payer: Cigna Commercial |
$8,247.25
|
| Rate for Payer: First Health Commercial |
$9,439.62
|
| Rate for Payer: Humana Commercial |
$8,445.97
|
| Rate for Payer: Humana KY Medicaid |
$3,417.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.88
|
| Rate for Payer: Aetna Commercial |
$7,651.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,744.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,452.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.30
|
| Rate for Payer: PHCS Commercial |
$9,538.98
|
| Rate for Payer: United Healthcare All Payer |
$8,744.07
|
|
|
PLATE DIST ANTEROLATRL TIB 8H
|
Facility
|
IP
|
$9,936.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.74 |
| Max. Negotiated Rate |
$9,538.98 |
| Rate for Payer: Aetna Commercial |
$7,651.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,750.42
|
| Rate for Payer: Cash Price |
$4,968.22
|
| Rate for Payer: Cigna Commercial |
$8,247.25
|
| Rate for Payer: First Health Commercial |
$9,439.62
|
| Rate for Payer: Humana Commercial |
$8,445.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,744.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,452.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.30
|
| Rate for Payer: PHCS Commercial |
$9,538.98
|
| Rate for Payer: United Healthcare All Payer |
$8,744.07
|
|
|
PLATE DIST ANT LAT TIB 4H*102
|
Facility
|
OP
|
$9,628.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.69 |
| Max. Negotiated Rate |
$9,243.28 |
| Rate for Payer: Aetna Commercial |
$7,413.88
|
| Rate for Payer: Anthem Medicaid |
$3,311.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,510.17
|
| Rate for Payer: Cash Price |
$4,814.21
|
| Rate for Payer: Cigna Commercial |
$7,991.59
|
| Rate for Payer: First Health Commercial |
$9,147.00
|
| Rate for Payer: Humana Commercial |
$8,184.16
|
| Rate for Payer: Humana KY Medicaid |
$3,311.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,344.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,895.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,105.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,377.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,473.01
|
| Rate for Payer: Ohio Health Group HMO |
$7,221.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.81
|
| Rate for Payer: PHCS Commercial |
$9,243.28
|
| Rate for Payer: United Healthcare All Payer |
$8,473.01
|
|
|
PLATE DIST ANT LAT TIB 4H*102
|
Facility
|
IP
|
$9,628.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.69 |
| Max. Negotiated Rate |
$9,243.28 |
| Rate for Payer: Aetna Commercial |
$7,413.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,510.17
|
| Rate for Payer: Cash Price |
$4,814.21
|
| Rate for Payer: Cigna Commercial |
$7,991.59
|
| Rate for Payer: First Health Commercial |
$9,147.00
|
| Rate for Payer: Humana Commercial |
$8,184.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,895.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,105.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,473.01
|
| Rate for Payer: Ohio Health Group HMO |
$7,221.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.81
|
| Rate for Payer: PHCS Commercial |
$9,243.28
|
| Rate for Payer: United Healthcare All Payer |
$8,473.01
|
|
|
PLATE DIST ANT LAT TIB L 8*153
|
Facility
|
OP
|
$9,936.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.74 |
| Max. Negotiated Rate |
$9,538.98 |
| Rate for Payer: Aetna Commercial |
$7,651.06
|
| Rate for Payer: Anthem Medicaid |
$3,417.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,750.42
|
| Rate for Payer: Cash Price |
$4,968.22
|
| Rate for Payer: Cigna Commercial |
$8,247.25
|
| Rate for Payer: First Health Commercial |
$9,439.62
|
| Rate for Payer: Humana Commercial |
$8,445.97
|
| Rate for Payer: Humana KY Medicaid |
$3,417.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,744.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,452.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.30
|
| Rate for Payer: PHCS Commercial |
$9,538.98
|
| Rate for Payer: United Healthcare All Payer |
$8,744.07
|
|
|
PLATE DIST ANT LAT TIB L 8*153
|
Facility
|
IP
|
$9,936.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.74 |
| Max. Negotiated Rate |
$9,538.98 |
| Rate for Payer: Aetna Commercial |
$7,651.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,750.42
|
| Rate for Payer: Cash Price |
$4,968.22
|
| Rate for Payer: Cigna Commercial |
$8,247.25
|
| Rate for Payer: First Health Commercial |
$9,439.62
|
| Rate for Payer: Humana Commercial |
$8,445.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,744.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,452.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.30
|
| Rate for Payer: PHCS Commercial |
$9,538.98
|
| Rate for Payer: United Healthcare All Payer |
$8,744.07
|
|
|
PLATE DIST CLAVICL 2.3MM 13H L
|
Facility
|
IP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Aetna Commercial |
$4,211.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
|
|
PLATE DIST CLAVICL 2.3MM 13H L
|
Facility
|
OP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Aetna Commercial |
$4,211.13
|
| Rate for Payer: Anthem Medicaid |
$1,880.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Humana KY Medicaid |
$1,880.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
|
|
PLATE DIST CLAVICL 2.3MM 13H R
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
PLATE DIST CLAVICL 2.3MM 13H R
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
PLATE DIST CLAVICL 2.3MM 16H L
|
Facility
|
IP
|
$6,552.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.79 |
| Max. Negotiated Rate |
$6,290.11 |
| Rate for Payer: Aetna Commercial |
$5,045.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,110.72
|
| Rate for Payer: Cash Price |
$3,276.10
|
| Rate for Payer: Cigna Commercial |
$5,438.33
|
| Rate for Payer: First Health Commercial |
$6,224.59
|
| Rate for Payer: Humana Commercial |
$5,569.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,372.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,835.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,965.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,765.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,914.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.18
|
| Rate for Payer: PHCS Commercial |
$6,290.11
|
| Rate for Payer: United Healthcare All Payer |
$5,765.94
|
|
|
PLATE DIST CLAVICL 2.3MM 16H L
|
Facility
|
OP
|
$6,552.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.79 |
| Max. Negotiated Rate |
$6,290.11 |
| Rate for Payer: Anthem Medicaid |
$2,253.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,110.72
|
| Rate for Payer: Cash Price |
$3,276.10
|
| Rate for Payer: Cigna Commercial |
$5,438.33
|
| Rate for Payer: First Health Commercial |
$6,224.59
|
| Rate for Payer: Humana Commercial |
$5,569.37
|
| Rate for Payer: Humana KY Medicaid |
$2,253.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,276.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,372.80
|
| Rate for Payer: Aetna Commercial |
$5,045.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,835.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,965.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,298.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,765.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,914.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.18
|
| Rate for Payer: PHCS Commercial |
$6,290.11
|
| Rate for Payer: United Healthcare All Payer |
$5,765.94
|
|
|
PLATE DIST CLAVICLE 2.3MM 16H
|
Facility
|
IP
|
$6,552.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.79 |
| Max. Negotiated Rate |
$6,290.11 |
| Rate for Payer: Aetna Commercial |
$5,045.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,110.72
|
| Rate for Payer: Cash Price |
$3,276.10
|
| Rate for Payer: Cigna Commercial |
$5,438.33
|
| Rate for Payer: First Health Commercial |
$6,224.59
|
| Rate for Payer: Humana Commercial |
$5,569.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,372.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,835.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,965.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,765.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,914.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.18
|
| Rate for Payer: PHCS Commercial |
$6,290.11
|
| Rate for Payer: United Healthcare All Payer |
$5,765.94
|
|
