|
PLATE DIST ANTEROLATERAL R 14H
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem Medicaid |
$2,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Humana KY Medicaid |
$2,638.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,691.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATERAL R 14H
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATERAL R 16H
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem Medicaid |
$2,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Humana KY Medicaid |
$2,638.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,691.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATERAL R 16H
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATRL TIB 8H
|
Facility
|
IP
|
$10,136.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.93 |
| Max. Negotiated Rate |
$9,730.98 |
| Rate for Payer: Aetna Commercial |
$7,805.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,906.42
|
| Rate for Payer: Cash Price |
$5,068.22
|
| Rate for Payer: Cigna Commercial |
$8,413.25
|
| Rate for Payer: First Health Commercial |
$9,629.62
|
| Rate for Payer: Humana Commercial |
$8,615.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,602.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,994.14
|
| Rate for Payer: PHCS Commercial |
$9,730.98
|
| Rate for Payer: United Healthcare All Payer |
$8,920.07
|
|
|
PLATE DIST ANTEROLATRL TIB 8H
|
Facility
|
OP
|
$10,136.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.93 |
| Max. Negotiated Rate |
$9,730.98 |
| Rate for Payer: Aetna Commercial |
$7,805.06
|
| Rate for Payer: Anthem Medicaid |
$3,485.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,906.42
|
| Rate for Payer: Cash Price |
$5,068.22
|
| Rate for Payer: Cigna Commercial |
$8,413.25
|
| Rate for Payer: First Health Commercial |
$9,629.62
|
| Rate for Payer: Humana Commercial |
$8,615.97
|
| Rate for Payer: Humana KY Medicaid |
$3,485.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,521.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,555.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,602.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,994.14
|
| Rate for Payer: PHCS Commercial |
$9,730.98
|
| Rate for Payer: United Healthcare All Payer |
$8,920.07
|
|
|
PLATE DIST ANT LAT TIB 4H*102
|
Facility
|
IP
|
$7,989.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.86 |
| Max. Negotiated Rate |
$7,669.97 |
| Rate for Payer: Aetna Commercial |
$6,151.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,231.85
|
| Rate for Payer: Cash Price |
$3,994.78
|
| Rate for Payer: Cigna Commercial |
$6,631.33
|
| Rate for Payer: First Health Commercial |
$7,590.07
|
| Rate for Payer: Humana Commercial |
$6,791.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,030.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,391.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,950.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,512.79
|
| Rate for Payer: PHCS Commercial |
$7,669.97
|
| Rate for Payer: United Healthcare All Payer |
$7,030.80
|
|
|
PLATE DIST ANT LAT TIB 4H*102
|
Facility
|
OP
|
$7,989.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,396.86 |
| Max. Negotiated Rate |
$7,669.97 |
| Rate for Payer: Aetna Commercial |
$6,151.95
|
| Rate for Payer: Anthem Medicaid |
$2,747.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,231.85
|
| Rate for Payer: Cash Price |
$3,994.78
|
| Rate for Payer: Cigna Commercial |
$6,631.33
|
| Rate for Payer: First Health Commercial |
$7,590.07
|
| Rate for Payer: Humana Commercial |
$6,791.12
|
| Rate for Payer: Humana KY Medicaid |
$2,747.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,775.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,802.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,030.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,391.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,950.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,512.79
|
| Rate for Payer: PHCS Commercial |
$7,669.97
|
| Rate for Payer: United Healthcare All Payer |
$7,030.80
|
|
|
PLATE DIST ANT LAT TIB L 8*153
|
Facility
|
IP
|
$10,136.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.93 |
| Max. Negotiated Rate |
$9,730.98 |
| Rate for Payer: Aetna Commercial |
$7,805.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,906.42
|
| Rate for Payer: Cash Price |
$5,068.22
|
| Rate for Payer: Cigna Commercial |
$8,413.25
|
| Rate for Payer: First Health Commercial |
$9,629.62
|
| Rate for Payer: Humana Commercial |
$8,615.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,602.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,994.14
|
| Rate for Payer: PHCS Commercial |
$9,730.98
|
| Rate for Payer: United Healthcare All Payer |
$8,920.07
|
|
|
PLATE DIST ANT LAT TIB L 8*153
|
Facility
|
OP
|
$10,136.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.93 |
| Max. Negotiated Rate |
$9,730.98 |
| Rate for Payer: Aetna Commercial |
$7,805.06
|
| Rate for Payer: Anthem Medicaid |
$3,485.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,906.42
|
| Rate for Payer: Cash Price |
$5,068.22
|
| Rate for Payer: Cigna Commercial |
$8,413.25
|
| Rate for Payer: First Health Commercial |
$9,629.62
|
| Rate for Payer: Humana Commercial |
$8,615.97
|
| Rate for Payer: Humana KY Medicaid |
$3,485.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,521.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,555.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,602.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,994.14
|
| Rate for Payer: PHCS Commercial |
$9,730.98
|
| Rate for Payer: United Healthcare All Payer |
$8,920.07
|
|
|
PLATE DIST CLAVICL 2.3MM 13H L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE DIST CLAVICL 2.3MM 13H L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE DIST CLAVICL 2.3MM 13H 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 DIST CLAVICL 2.3MM 13H 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 DIST CLAVICL 2.3MM 16H L
|
Facility
|
IP
|
$6,752.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.66 |
| Max. Negotiated Rate |
$6,482.11 |
| Rate for Payer: Aetna Commercial |
$5,199.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,266.72
|
| Rate for Payer: Cash Price |
$3,376.10
|
| Rate for Payer: Cigna Commercial |
$5,604.33
|
| Rate for Payer: First Health Commercial |
$6,414.59
|
| Rate for Payer: Humana Commercial |
$5,739.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,536.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,983.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,025.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,941.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,064.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,874.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.02
|
| Rate for Payer: PHCS Commercial |
$6,482.11
|
| Rate for Payer: United Healthcare All Payer |
$5,941.94
|
|
|
PLATE DIST CLAVICL 2.3MM 16H L
|
Facility
|
OP
|
$6,752.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.66 |
| Max. Negotiated Rate |
$6,482.11 |
| Rate for Payer: Aetna Commercial |
$5,199.19
|
| Rate for Payer: Anthem Medicaid |
$2,322.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,266.72
|
| Rate for Payer: Cash Price |
$3,376.10
|
| Rate for Payer: Cigna Commercial |
$5,604.33
|
| Rate for Payer: First Health Commercial |
$6,414.59
|
| Rate for Payer: Humana Commercial |
$5,739.37
|
| Rate for Payer: Humana KY Medicaid |
$2,322.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,345.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,536.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,983.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,025.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,368.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,941.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,064.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,874.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.02
|
| Rate for Payer: PHCS Commercial |
$6,482.11
|
| Rate for Payer: United Healthcare All Payer |
$5,941.94
|
|
|
PLATE DIST CLAVICLE 2.3MM 16H
|
Facility
|
IP
|
$6,752.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.66 |
| Max. Negotiated Rate |
$6,482.11 |
| Rate for Payer: Aetna Commercial |
$5,199.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,266.72
|
| Rate for Payer: Cash Price |
$3,376.10
|
| Rate for Payer: Cigna Commercial |
$5,604.33
|
| Rate for Payer: First Health Commercial |
$6,414.59
|
| Rate for Payer: Humana Commercial |
$5,739.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,536.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,983.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,025.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,941.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,064.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,874.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.02
|
| Rate for Payer: PHCS Commercial |
$6,482.11
|
| Rate for Payer: United Healthcare All Payer |
$5,941.94
|
|
|
PLATE DIST CLAVICLE 2.3MM 16H
|
Facility
|
OP
|
$6,752.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.66 |
| Max. Negotiated Rate |
$6,482.11 |
| Rate for Payer: Aetna Commercial |
$5,199.19
|
| Rate for Payer: Anthem Medicaid |
$2,322.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,266.72
|
| Rate for Payer: Cash Price |
$3,376.10
|
| Rate for Payer: Cigna Commercial |
$5,604.33
|
| Rate for Payer: First Health Commercial |
$6,414.59
|
| Rate for Payer: Humana Commercial |
$5,739.37
|
| Rate for Payer: Humana KY Medicaid |
$2,322.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,345.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,536.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,983.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,025.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,368.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,941.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,064.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,874.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.02
|
| Rate for Payer: PHCS Commercial |
$6,482.11
|
| Rate for Payer: United Healthcare All Payer |
$5,941.94
|
|
|
PLATE DIST CLAVICLE 3.5 16H L
|
Facility
|
OP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem Medicaid |
$1,916.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Humana KY Medicaid |
$1,916.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DIST CLAVICLE 3.5 16H L
|
Facility
|
IP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DIST CLAVICLE 3.5 16H R
|
Facility
|
IP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DIST CLAVICLE 3.5 16H R
|
Facility
|
OP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem Medicaid |
$1,916.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Humana KY Medicaid |
$1,916.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DIST CLAVICLE 3.5MM 12H
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE DIST CLAVICLE 3.5MM 12H
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE DIST CLAVICLE 3.5MM 9H L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
