|
ULNA COMPONENT LRG LEFT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT LRG RIGHT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT LRG RIGHT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT SM LEFT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT SM LEFT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT SM RIGHT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT SM RIGHT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT STD LEFT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT STD LEFT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT STD RIGHT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNA COMPONENT STD RIGHT
|
Facility
|
OP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem Medicaid |
$4,059.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Humana KY Medicaid |
$4,059.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,100.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,140.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
|
ULNAR ASSY TOT ELBOW REG L 3.5
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
ULNAR ASSY TOT ELBOW REG L 3.5
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
ULNAR ASSY TOT ELBOW XSM 3IN L
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
ULNAR ASSY TOT ELBOW XSM 3IN L
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
ULNAR LEFT 85MM STD
|
Facility
|
IP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ULNAR LEFT 85MM STD
|
Facility
|
OP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem Medicaid |
$3,491.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Humana KY Medicaid |
$3,491.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ULNAR RIGHT 60MM STD
|
Facility
|
IP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ULNAR RIGHT 60MM STD
|
Facility
|
OP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ULNAR RIGHT 85MM STD
|
Facility
|
OP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem Medicaid |
$3,491.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Humana KY Medicaid |
$3,491.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ULNAR RIGHT 85MM STD
|
Facility
|
IP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ULORIC 40MG TABLET
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
25001621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
ULORIC 40MG TABLET
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 64764091830
|
| Hospital Charge Code |
25001621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem Medicaid |
$9.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Humana KY Medicaid |
$9.63
|
| Rate for Payer: Kentucky WC Medicaid |
$9.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
ULORIC 80MG TABLET
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 64764067730
|
| Hospital Charge Code |
25001622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
ULORIC 80MG TABLET
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 64764067730
|
| Hospital Charge Code |
25001622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem Medicaid |
$9.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Humana KY Medicaid |
$9.63
|
| Rate for Payer: Kentucky WC Medicaid |
$9.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
