|
PLATE LAT DIST HM LK 5H 77M L
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LAT DIST HM LK 7H 102M L
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIST HM LK 7H 102M L
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIST HM LK 9H 128M L
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIST HM LK 9H 128M L
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIST HUM LK 5 77MM R
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LAT DIST HUM LK 5 77MM R
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LAT DST HM LK 11H 153M L
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE LAT DST HM LK 11H 153M L
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE LAT DST HUM LK 7 102M R
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DST HUM LK 7 102M R
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DST HUM LK 9 128M R
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DST HUM LK 9 128M R
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LATERAL ANT CLAVICLE 6H
|
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 LATERAL ANT CLAVICLE 6H
|
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 LATERAL ANT CLAVICLE 8H
|
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 LATERAL ANT CLAVICLE 8H
|
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 LATERAL FIBULA 4H L
|
Facility
|
OP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem Medicaid |
$1,626.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Humana KY Medicaid |
$1,626.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE LATERAL FIBULA 4H L
|
Facility
|
IP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE LATERAL FIBULA 4H R
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA 4H R
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA 5H L
|
Facility
|
IP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE LATERAL FIBULA 5H L
|
Facility
|
OP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem Medicaid |
$1,643.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Humana KY Medicaid |
$1,643.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE LATERAL FIBULA 5H R
|
Facility
|
OP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem Medicaid |
$1,643.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Humana KY Medicaid |
$1,643.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE LATERAL FIBULA 5H R
|
Facility
|
IP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
