|
PLATE FLAT T 5H
|
Facility
|
OP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem Medicaid |
$1,398.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Humana KY Medicaid |
$1,398.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 6H
|
Facility
|
OP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem Medicaid |
$1,398.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Humana KY Medicaid |
$1,398.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 6H
|
Facility
|
IP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 7H
|
Facility
|
IP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 7H
|
Facility
|
OP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem Medicaid |
$1,398.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Humana KY Medicaid |
$1,398.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FRACTURE 14H
|
Facility
|
OP
|
$4,528.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.46 |
| Max. Negotiated Rate |
$4,347.08 |
| Rate for Payer: Aetna Commercial |
$3,486.72
|
| Rate for Payer: Anthem Medicaid |
$1,557.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.00
|
| Rate for Payer: Cash Price |
$2,264.11
|
| Rate for Payer: Cigna Commercial |
$3,758.41
|
| Rate for Payer: First Health Commercial |
$4,301.80
|
| Rate for Payer: Humana Commercial |
$3,848.98
|
| Rate for Payer: Humana KY Medicaid |
$1,557.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,573.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,341.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,984.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,622.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,939.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,124.46
|
| Rate for Payer: PHCS Commercial |
$4,347.08
|
| Rate for Payer: United Healthcare All Payer |
$3,984.82
|
|
|
PLATE FRACTURE 14H
|
Facility
|
IP
|
$4,528.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.46 |
| Max. Negotiated Rate |
$4,347.08 |
| Rate for Payer: Aetna Commercial |
$3,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.00
|
| Rate for Payer: Cash Price |
$2,264.11
|
| Rate for Payer: Cigna Commercial |
$3,758.41
|
| Rate for Payer: First Health Commercial |
$4,301.80
|
| Rate for Payer: Humana Commercial |
$3,848.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,341.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,984.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,622.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,939.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,124.46
|
| Rate for Payer: PHCS Commercial |
$4,347.08
|
| Rate for Payer: United Healthcare All Payer |
$3,984.82
|
|
|
PLATE FRACTURE 4H
|
Facility
|
IP
|
$3,339.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.79 |
| Max. Negotiated Rate |
$3,205.74 |
| Rate for Payer: Aetna Commercial |
$2,571.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,604.66
|
| Rate for Payer: Cash Price |
$1,669.66
|
| Rate for Payer: Cigna Commercial |
$2,771.63
|
| Rate for Payer: First Health Commercial |
$3,172.34
|
| Rate for Payer: Humana Commercial |
$2,838.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,938.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,504.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.12
|
| Rate for Payer: PHCS Commercial |
$3,205.74
|
| Rate for Payer: United Healthcare All Payer |
$2,938.59
|
|
|
PLATE FRACTURE 4H
|
Facility
|
OP
|
$3,339.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.79 |
| Max. Negotiated Rate |
$3,205.74 |
| Rate for Payer: Aetna Commercial |
$2,571.27
|
| Rate for Payer: Anthem Medicaid |
$1,148.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,604.66
|
| Rate for Payer: Cash Price |
$1,669.66
|
| Rate for Payer: Cigna Commercial |
$2,771.63
|
| Rate for Payer: First Health Commercial |
$3,172.34
|
| Rate for Payer: Humana Commercial |
$2,838.41
|
| Rate for Payer: Humana KY Medicaid |
$1,148.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,938.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,504.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.12
|
| Rate for Payer: PHCS Commercial |
$3,205.74
|
| Rate for Payer: United Healthcare All Payer |
$2,938.59
|
|
|
PLATE FRACTURE 4H C SHAPE
|
Facility
|
IP
|
$3,434.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$3,297.32 |
| Rate for Payer: Aetna Commercial |
$2,644.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,679.07
|
| Rate for Payer: Cash Price |
$1,717.36
|
| Rate for Payer: Cigna Commercial |
$2,850.81
|
| Rate for Payer: First Health Commercial |
$3,262.97
|
| Rate for Payer: Humana Commercial |
$2,919.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,816.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,576.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,988.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.95
|
| Rate for Payer: PHCS Commercial |
$3,297.32
|
| Rate for Payer: United Healthcare All Payer |
$3,022.54
|
|
|
PLATE FRACTURE 4H C SHAPE
|
Facility
|
OP
|
$3,434.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$3,297.32 |
| Rate for Payer: Aetna Commercial |
$2,644.73
|
| Rate for Payer: Anthem Medicaid |
$1,181.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,679.07
|
| Rate for Payer: Cash Price |
$1,717.36
|
| Rate for Payer: Cigna Commercial |
$2,850.81
|
| Rate for Payer: First Health Commercial |
$3,262.97
|
| Rate for Payer: Humana Commercial |
$2,919.50
|
| Rate for Payer: Humana KY Medicaid |
$1,181.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,193.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,816.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,576.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,988.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.95
|
| Rate for Payer: PHCS Commercial |
$3,297.32
|
| Rate for Payer: United Healthcare All Payer |
$3,022.54
|
|
|
PLATE FRACTURE 4H WITH BAR
|
Facility
|
OP
|
$3,387.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.10 |
| Max. Negotiated Rate |
$3,251.53 |
| Rate for Payer: Aetna Commercial |
$2,608.00
|
| Rate for Payer: Anthem Medicaid |
$1,164.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.87
|
| Rate for Payer: Cash Price |
$1,693.51
|
| Rate for Payer: Cigna Commercial |
$2,811.22
|
| Rate for Payer: First Health Commercial |
$3,217.66
|
| Rate for Payer: Humana Commercial |
$2,878.96
|
| Rate for Payer: Humana KY Medicaid |
$1,164.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,176.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,777.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,499.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,188.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,980.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,540.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,709.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,946.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,337.04
|
| Rate for Payer: PHCS Commercial |
$3,251.53
|
| Rate for Payer: United Healthcare All Payer |
$2,980.57
|
|
|
PLATE FRACTURE 4H WITH BAR
|
Facility
|
IP
|
$3,387.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.10 |
| Max. Negotiated Rate |
$3,251.53 |
| Rate for Payer: Aetna Commercial |
$2,608.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.87
|
| Rate for Payer: Cash Price |
$1,693.51
|
| Rate for Payer: Cigna Commercial |
$2,811.22
|
| Rate for Payer: First Health Commercial |
$3,217.66
|
| Rate for Payer: Humana Commercial |
$2,878.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,777.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,499.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,980.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,540.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,709.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,946.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,337.04
|
| Rate for Payer: PHCS Commercial |
$3,251.53
|
| Rate for Payer: United Healthcare All Payer |
$2,980.57
|
|
|
PLATE FRACTURE 6H
|
Facility
|
OP
|
$3,625.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.66 |
| Max. Negotiated Rate |
$3,480.53 |
| Rate for Payer: Aetna Commercial |
$2,791.67
|
| Rate for Payer: Anthem Medicaid |
$1,246.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,827.93
|
| Rate for Payer: Cash Price |
$1,812.78
|
| Rate for Payer: Cigna Commercial |
$3,009.21
|
| Rate for Payer: First Health Commercial |
$3,444.27
|
| Rate for Payer: Humana Commercial |
$3,081.72
|
| Rate for Payer: Humana KY Medicaid |
$1,246.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,259.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,972.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,675.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,271.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,190.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,719.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,900.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,154.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,501.63
|
| Rate for Payer: PHCS Commercial |
$3,480.53
|
| Rate for Payer: United Healthcare All Payer |
$3,190.48
|
|
|
PLATE FRACTURE 6H
|
Facility
|
IP
|
$3,625.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.66 |
| Max. Negotiated Rate |
$3,480.53 |
| Rate for Payer: Aetna Commercial |
$2,791.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,827.93
|
| Rate for Payer: Cash Price |
$1,812.78
|
| Rate for Payer: Cigna Commercial |
$3,009.21
|
| Rate for Payer: First Health Commercial |
$3,444.27
|
| Rate for Payer: Humana Commercial |
$3,081.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,972.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,675.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,190.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,719.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,900.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,154.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,501.63
|
| Rate for Payer: PHCS Commercial |
$3,480.53
|
| Rate for Payer: United Healthcare All Payer |
$3,190.48
|
|
|
PLATE FRACTURE 6H 115 DEG
|
Facility
|
OP
|
$4,385.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.53 |
| Max. Negotiated Rate |
$4,209.71 |
| Rate for Payer: Aetna Commercial |
$3,376.53
|
| Rate for Payer: Anthem Medicaid |
$1,508.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,420.39
|
| Rate for Payer: Cash Price |
$2,192.56
|
| Rate for Payer: Cigna Commercial |
$3,639.64
|
| Rate for Payer: First Health Commercial |
$4,165.85
|
| Rate for Payer: Humana Commercial |
$3,727.34
|
| Rate for Payer: Humana KY Medicaid |
$1,508.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,595.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,236.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,315.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,538.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,858.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,288.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,025.73
|
| Rate for Payer: PHCS Commercial |
$4,209.71
|
| Rate for Payer: United Healthcare All Payer |
$3,858.90
|
|
|
PLATE FRACTURE 6H 115 DEG
|
Facility
|
IP
|
$4,385.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.53 |
| Max. Negotiated Rate |
$4,209.71 |
| Rate for Payer: Aetna Commercial |
$3,376.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,420.39
|
| Rate for Payer: Cash Price |
$2,192.56
|
| Rate for Payer: Cigna Commercial |
$3,639.64
|
| Rate for Payer: First Health Commercial |
$4,165.85
|
| Rate for Payer: Humana Commercial |
$3,727.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,595.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,236.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,315.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,858.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,288.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,508.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,025.73
|
| Rate for Payer: PHCS Commercial |
$4,209.71
|
| Rate for Payer: United Healthcare All Payer |
$3,858.90
|
|
|
PLATE FRACTURE 6H 140 DEG
|
Facility
|
IP
|
$4,432.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.84 |
| Max. Negotiated Rate |
$4,255.50 |
| Rate for Payer: Aetna Commercial |
$3,413.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,457.59
|
| Rate for Payer: Cash Price |
$2,216.41
|
| Rate for Payer: Cigna Commercial |
$3,679.23
|
| Rate for Payer: First Health Commercial |
$4,211.17
|
| Rate for Payer: Humana Commercial |
$3,767.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,634.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,271.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,900.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,324.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,546.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,856.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,058.64
|
| Rate for Payer: PHCS Commercial |
$4,255.50
|
| Rate for Payer: United Healthcare All Payer |
$3,900.87
|
|
|
PLATE FRACTURE 6H 140 DEG
|
Facility
|
OP
|
$4,432.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.84 |
| Max. Negotiated Rate |
$4,255.50 |
| Rate for Payer: Aetna Commercial |
$3,413.26
|
| Rate for Payer: Anthem Medicaid |
$1,524.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,457.59
|
| Rate for Payer: Cash Price |
$2,216.41
|
| Rate for Payer: Cigna Commercial |
$3,679.23
|
| Rate for Payer: First Health Commercial |
$4,211.17
|
| Rate for Payer: Humana Commercial |
$3,767.89
|
| Rate for Payer: Humana KY Medicaid |
$1,524.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,634.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,271.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,900.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,324.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,546.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,856.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,058.64
|
| Rate for Payer: PHCS Commercial |
$4,255.50
|
| Rate for Payer: United Healthcare All Payer |
$3,900.87
|
|
|
PLATE FRACTURE 6H WITH BAR
|
Facility
|
IP
|
$3,764.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.49 |
| Max. Negotiated Rate |
$3,614.38 |
| Rate for Payer: Aetna Commercial |
$2,899.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.68
|
| Rate for Payer: Cash Price |
$1,882.49
|
| Rate for Payer: Cigna Commercial |
$3,124.93
|
| Rate for Payer: First Health Commercial |
$3,576.73
|
| Rate for Payer: Humana Commercial |
$3,200.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,087.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,778.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,313.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,011.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,275.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$3,614.38
|
| Rate for Payer: United Healthcare All Payer |
$3,313.18
|
|
|
PLATE FRACTURE 6H WITH BAR
|
Facility
|
OP
|
$3,764.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.49 |
| Max. Negotiated Rate |
$3,614.38 |
| Rate for Payer: Aetna Commercial |
$2,899.03
|
| Rate for Payer: Anthem Medicaid |
$1,294.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.68
|
| Rate for Payer: Cash Price |
$1,882.49
|
| Rate for Payer: Cigna Commercial |
$3,124.93
|
| Rate for Payer: First Health Commercial |
$3,576.73
|
| Rate for Payer: Humana Commercial |
$3,200.23
|
| Rate for Payer: Humana KY Medicaid |
$1,294.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,307.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,087.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,778.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,320.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,313.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,011.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,275.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$3,614.38
|
| Rate for Payer: United Healthcare All Payer |
$3,313.18
|
|
|
PLATE FRAGMENT 2.7*60
|
Facility
|
IP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE FRAGMENT 2.7*60
|
Facility
|
OP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem Medicaid |
$1,082.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Humana KY Medicaid |
$1,082.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE FULL RECON MAND 5528932
|
Facility
|
IP
|
$7,733.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.94 |
| Max. Negotiated Rate |
$7,423.81 |
| Rate for Payer: Aetna Commercial |
$5,954.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.85
|
| Rate for Payer: Cash Price |
$3,866.57
|
| Rate for Payer: Cigna Commercial |
$6,418.51
|
| Rate for Payer: First Health Commercial |
$7,346.48
|
| Rate for Payer: Humana Commercial |
$6,573.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,707.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,186.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,727.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.87
|
| Rate for Payer: PHCS Commercial |
$7,423.81
|
| Rate for Payer: United Healthcare All Payer |
$6,805.16
|
|
|
PLATE FULL RECON MAND 5528932
|
Facility
|
OP
|
$7,733.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.94 |
| Max. Negotiated Rate |
$7,423.81 |
| Rate for Payer: Aetna Commercial |
$5,954.52
|
| Rate for Payer: Anthem Medicaid |
$2,659.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.85
|
| Rate for Payer: Cash Price |
$3,866.57
|
| Rate for Payer: Cigna Commercial |
$6,418.51
|
| Rate for Payer: First Health Commercial |
$7,346.48
|
| Rate for Payer: Humana Commercial |
$6,573.17
|
| Rate for Payer: Humana KY Medicaid |
$2,659.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,686.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,707.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,186.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,727.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.87
|
| Rate for Payer: PHCS Commercial |
$7,423.81
|
| Rate for Payer: United Healthcare All Payer |
$6,805.16
|
|
