|
UA W/ MICRO
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$39.36 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Anthem Medicaid |
$14.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$34.03
|
| Rate for Payer: First Health Commercial |
$38.95
|
| Rate for Payer: Humana Commercial |
$34.85
|
| Rate for Payer: Humana KY Medicaid |
$14.10
|
| Rate for Payer: Humana Medicare Advantage |
$3.17
|
| Rate for Payer: Kentucky WC Medicaid |
$14.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.08
|
| Rate for Payer: Ohio Health Group HMO |
$30.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.71
|
| Rate for Payer: PHCS Commercial |
$39.36
|
| Rate for Payer: United Healthcare All Payer |
$36.08
|
|
|
UA W/ MICRO
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$39.36 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.92
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$34.03
|
| Rate for Payer: First Health Commercial |
$38.95
|
| Rate for Payer: Humana Commercial |
$34.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.08
|
| Rate for Payer: Ohio Health Group HMO |
$30.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.71
|
| Rate for Payer: PHCS Commercial |
$39.36
|
| Rate for Payer: United Healthcare All Payer |
$36.08
|
|
|
UDENYCA 6MG/0.6ML SYRINGE
|
Facility
|
IP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25002736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,957.99 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,550.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,053.66
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA 6MG/0.6ML SYRINGE
|
Facility
|
OP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25002736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem Medicaid |
$7,825.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$170.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.84
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Humana KY Medicaid |
$7,825.01
|
| Rate for Payer: Humana Medicare Advantage |
$122.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,550.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,053.66
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA OBI 0.5MG(6MG/0.6ML)
|
Facility
|
IP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25004491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,957.99 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,550.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,053.66
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA OBI 0.5MG(6MG/0.6ML)
|
Facility
|
OP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25004491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem Medicaid |
$7,825.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$170.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.84
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Humana KY Medicaid |
$7,825.01
|
| Rate for Payer: Humana Medicare Advantage |
$122.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,550.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,053.66
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
ULNA COMPONENT LRG LEFT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT LRG LEFT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT LRG RIGHT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT LRG RIGHT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT SM LEFT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT SM LEFT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT SM RIGHT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT SM RIGHT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT STD LEFT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT STD LEFT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT STD RIGHT
|
Facility
|
OP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem Medicaid |
$3,974.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Humana KY Medicaid |
$3,974.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNA COMPONENT STD RIGHT
|
Facility
|
IP
|
$11,557.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.51 |
| Max. Negotiated Rate |
$11,095.45 |
| Rate for Payer: Aetna Commercial |
$8,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,015.05
|
| Rate for Payer: Cash Price |
$5,778.88
|
| Rate for Payer: Cigna Commercial |
$9,592.94
|
| Rate for Payer: First Health Commercial |
$10,979.87
|
| Rate for Payer: Humana Commercial |
$9,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,311.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,502.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.91
|
| Rate for Payer: PHCS Commercial |
$11,095.45
|
| Rate for Payer: United Healthcare All Payer |
$10,170.83
|
|
|
ULNAR ASSY TOT ELBOW REG L 3.5
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
ULNAR ASSY TOT ELBOW REG L 3.5
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
ULNAR ASSY TOT ELBOW XSM 3IN L
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
ULNAR ASSY TOT ELBOW XSM 3IN L
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
ULNAR LEFT 85MM STD
|
Facility
|
OP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem Medicaid |
$3,423.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Humana KY Medicaid |
$3,423.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
ULNAR LEFT 85MM STD
|
Facility
|
IP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
ULNAR RIGHT 60MM STD
|
Facility
|
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
