|
PLATE DIST CLAVICLE 2.3MM 16H
|
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: Aetna Commercial |
$5,045.19
|
| 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: 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 3.5 16H L
|
Facility
|
IP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DIST CLAVICLE 3.5 16H L
|
Facility
|
OP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem Medicaid |
$1,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Humana KY Medicaid |
$1,903.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DIST CLAVICLE 3.5 16H R
|
Facility
|
IP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DIST CLAVICLE 3.5 16H R
|
Facility
|
OP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem Medicaid |
$1,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Humana KY Medicaid |
$1,903.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DIST CLAVICLE 3.5MM 12H
|
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 CLAVICLE 3.5MM 12H
|
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 CLAVICLE 3.5MM 9H 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: 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: Aetna Commercial |
$4,211.13
|
| 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 CLAVICLE 3.5MM 9H 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 CLAVICLE 3.5MM 9H R
|
Facility
|
OP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem Medicaid |
$1,653.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Humana KY Medicaid |
$1,653.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
PLATE DIST CLAVICLE 3.5MM 9H R
|
Facility
|
IP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
PLATE DIST FEM 12 HOLE L
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE DIST FEM 12 HOLE L
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE DIST FEM 12 HOLE R
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE DIST FEM 12 HOLE R
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE DIST FEM 15 HOLE L
|
Facility
|
IP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE DIST FEM 15 HOLE L
|
Facility
|
OP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem Medicaid |
$3,715.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Humana KY Medicaid |
$3,715.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,753.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,790.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE DIST FEM 15 HOLE R
|
Facility
|
IP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE DIST FEM 15 HOLE R
|
Facility
|
OP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Anthem Medicaid |
$3,715.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Humana KY Medicaid |
$3,715.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,753.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,790.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE DIST FEM 18 HOLE L
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE DIST FEM 18 HOLE L
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE DIST FEM 18 HOLE R
|
Facility
|
OP
|
$10,986.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.30 |
| Max. Negotiated Rate |
$10,547.42 |
| Rate for Payer: Aetna Commercial |
$8,459.91
|
| Rate for Payer: Anthem Medicaid |
$3,778.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,569.78
|
| Rate for Payer: Cash Price |
$5,493.45
|
| Rate for Payer: Cigna Commercial |
$9,119.13
|
| Rate for Payer: First Health Commercial |
$10,437.56
|
| Rate for Payer: Humana Commercial |
$9,338.86
|
| Rate for Payer: Humana KY Medicaid |
$3,778.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,816.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,009.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,108.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,296.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,854.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,668.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,240.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,197.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,405.94
|
| Rate for Payer: PHCS Commercial |
$10,547.42
|
| Rate for Payer: United Healthcare All Payer |
$9,668.47
|
|
|
PLATE DIST FEM 18 HOLE R
|
Facility
|
IP
|
$10,986.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.30 |
| Max. Negotiated Rate |
$10,547.42 |
| Rate for Payer: Aetna Commercial |
$8,459.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,569.78
|
| Rate for Payer: Cash Price |
$5,493.45
|
| Rate for Payer: Cigna Commercial |
$9,119.13
|
| Rate for Payer: First Health Commercial |
$10,437.56
|
| Rate for Payer: Humana Commercial |
$9,338.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,009.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,108.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,296.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,668.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,240.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,197.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,405.94
|
| Rate for Payer: PHCS Commercial |
$10,547.42
|
| Rate for Payer: United Healthcare All Payer |
$9,668.47
|
|
|
PLATE DIST FEM 21 HOLE L
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE DIST FEM 21 HOLE L
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
