|
PLATE CLAVICLE LP 8H LRG L
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.70 |
| Max. Negotiated Rate |
$6,594.24 |
| Rate for Payer: Aetna Commercial |
$5,289.13
|
| Rate for Payer: Anthem Medicaid |
$2,362.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.82
|
| Rate for Payer: Cash Price |
$3,434.50
|
| Rate for Payer: Cigna Commercial |
$5,701.27
|
| Rate for Payer: First Health Commercial |
$6,525.55
|
| Rate for Payer: Humana Commercial |
$5,838.65
|
| Rate for Payer: Humana KY Medicaid |
$2,362.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,386.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,069.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,409.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,976.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.61
|
| Rate for Payer: PHCS Commercial |
$6,594.24
|
| Rate for Payer: United Healthcare All Payer |
$6,044.72
|
|
|
PLATE CLAVICLE LP 8H LRG L
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.70 |
| Max. Negotiated Rate |
$6,594.24 |
| Rate for Payer: Aetna Commercial |
$5,289.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.82
|
| Rate for Payer: Cash Price |
$3,434.50
|
| Rate for Payer: Cigna Commercial |
$5,701.27
|
| Rate for Payer: First Health Commercial |
$6,525.55
|
| Rate for Payer: Humana Commercial |
$5,838.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,069.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,976.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.61
|
| Rate for Payer: PHCS Commercial |
$6,594.24
|
| Rate for Payer: United Healthcare All Payer |
$6,044.72
|
|
|
PLATE CLAVICLE LP 8H LRG R
|
Facility
|
OP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem Medicaid |
$2,539.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Humana KY Medicaid |
$2,539.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,565.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,590.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE CLAVICLE LP 8H LRG R
|
Facility
|
IP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE CLAVICLE LP 8H MED L
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H MED L
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H MED R
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H MED R
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H SM L
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H SM L
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H SM R
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H SM R
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H STR L
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H STR L
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAVICLE LP 8H STR R
|
Facility
|
IP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
PLATE CLAVICLE LP 8H STR R
|
Facility
|
OP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem Medicaid |
$1,928.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Humana KY Medicaid |
$1,928.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,948.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,967.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
PLATE CLAVICLE NRW PROF 8H R
|
Facility
|
OP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem Medicaid |
$1,928.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Humana KY Medicaid |
$1,928.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,948.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,967.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
PLATE CLAVICLE NRW PROF 8H R
|
Facility
|
IP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
PLATE CLAV INF DIST 81MM
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV INF DIST 81MM
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV INF MED 10H 117MM
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV INF MED 10H 117MM
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV INF MED 6H 73MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV INF MED 6H 73MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV INF MED 7H 85MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
