|
DISCOVERY ELBOW 4*150MM LT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 4*150MM LT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 4*150MM RT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 4*150MM RT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 4*75MM RT ULNA
|
Facility
|
OP
|
$17,523.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.07 |
| Max. Negotiated Rate |
$16,822.66 |
| Rate for Payer: Aetna Commercial |
$13,493.17
|
| Rate for Payer: Anthem Medicaid |
$6,026.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.41
|
| Rate for Payer: Cash Price |
$8,761.80
|
| Rate for Payer: Cigna Commercial |
$14,544.59
|
| Rate for Payer: First Health Commercial |
$16,647.42
|
| Rate for Payer: Humana Commercial |
$14,895.06
|
| Rate for Payer: Humana KY Medicaid |
$6,026.37
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,420.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,142.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,278.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,432.32
|
| Rate for Payer: PHCS Commercial |
$16,822.66
|
| Rate for Payer: United Healthcare All Payer |
$15,420.77
|
|
|
DISCOVERY ELBOW 4*75MM RT ULNA
|
Facility
|
IP
|
$17,523.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.07 |
| Max. Negotiated Rate |
$16,822.66 |
| Rate for Payer: Aetna Commercial |
$13,493.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.41
|
| Rate for Payer: Cash Price |
$8,761.80
|
| Rate for Payer: Cigna Commercial |
$14,544.59
|
| Rate for Payer: First Health Commercial |
$16,647.42
|
| Rate for Payer: Humana Commercial |
$14,895.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,420.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,142.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,278.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,432.32
|
| Rate for Payer: PHCS Commercial |
$16,822.66
|
| Rate for Payer: United Healthcare All Payer |
$15,420.77
|
|
|
DISCOVERY ELBOW 5*100MM LT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 5*100MM LT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 5*150MM LT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 5*150MM LT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 5*150MM RT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 5*150MM RT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*100MM LT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*100MM LT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*100MM RT HUM
|
Facility
|
OP
|
$16,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.01 |
| Max. Negotiated Rate |
$15,640.70 |
| Rate for Payer: Aetna Commercial |
$12,545.15
|
| Rate for Payer: Anthem Medicaid |
$5,602.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,708.07
|
| Rate for Payer: Cash Price |
$8,146.20
|
| Rate for Payer: Cigna Commercial |
$13,522.69
|
| Rate for Payer: First Health Commercial |
$15,477.78
|
| Rate for Payer: Humana Commercial |
$13,848.54
|
| Rate for Payer: Humana KY Medicaid |
$5,602.96
|
| Rate for Payer: Kentucky WC Medicaid |
$5,659.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,359.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,023.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,887.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,715.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,337.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,219.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,258.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,118.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,050.64
|
| Rate for Payer: PHCS Commercial |
$15,640.70
|
| Rate for Payer: United Healthcare All Payer |
$14,337.31
|
|
|
DISCOVERY ELBOW 6*100MM RT HUM
|
Facility
|
IP
|
$16,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.01 |
| Max. Negotiated Rate |
$15,640.70 |
| Rate for Payer: Aetna Commercial |
$12,545.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,708.07
|
| Rate for Payer: Cash Price |
$8,146.20
|
| Rate for Payer: Cigna Commercial |
$13,522.69
|
| Rate for Payer: First Health Commercial |
$15,477.78
|
| Rate for Payer: Humana Commercial |
$13,848.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,359.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,023.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,887.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,337.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,219.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,258.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,118.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,050.64
|
| Rate for Payer: PHCS Commercial |
$15,640.70
|
| Rate for Payer: United Healthcare All Payer |
$14,337.31
|
|
|
DISCOVERY ELBOW 6*150MM LT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*150MM LT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*150MM RT HUM
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW 6*150MM RT HUM
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
DISCOVERY ELBOW HUM FLNG 5*100
|
Facility
|
IP
|
$16,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.01 |
| Max. Negotiated Rate |
$15,640.70 |
| Rate for Payer: Aetna Commercial |
$12,545.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,708.07
|
| Rate for Payer: Cash Price |
$8,146.20
|
| Rate for Payer: Cigna Commercial |
$13,522.69
|
| Rate for Payer: First Health Commercial |
$15,477.78
|
| Rate for Payer: Humana Commercial |
$13,848.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,359.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,023.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,887.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,337.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,219.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,258.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,118.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,050.64
|
| Rate for Payer: PHCS Commercial |
$15,640.70
|
| Rate for Payer: United Healthcare All Payer |
$14,337.31
|
|
|
DISCOVERY ELBOW HUM FLNG 5*100
|
Facility
|
OP
|
$16,292.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.01 |
| Max. Negotiated Rate |
$15,640.70 |
| Rate for Payer: Aetna Commercial |
$12,545.15
|
| Rate for Payer: Anthem Medicaid |
$5,602.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,708.07
|
| Rate for Payer: Cash Price |
$8,146.20
|
| Rate for Payer: Cigna Commercial |
$13,522.69
|
| Rate for Payer: First Health Commercial |
$15,477.78
|
| Rate for Payer: Humana Commercial |
$13,848.54
|
| Rate for Payer: Humana KY Medicaid |
$5,602.96
|
| Rate for Payer: Kentucky WC Medicaid |
$5,659.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,359.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,023.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,887.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,715.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,337.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,219.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,258.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,118.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,050.64
|
| Rate for Payer: PHCS Commercial |
$15,640.70
|
| Rate for Payer: United Healthcare All Payer |
$14,337.31
|
|
|
DISCOVERY ELBOW ULNA 3*115M L
|
Facility
|
OP
|
$17,523.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.07 |
| Max. Negotiated Rate |
$16,822.66 |
| Rate for Payer: Aetna Commercial |
$13,493.17
|
| Rate for Payer: Anthem Medicaid |
$6,026.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.41
|
| Rate for Payer: Cash Price |
$8,761.80
|
| Rate for Payer: Cigna Commercial |
$14,544.59
|
| Rate for Payer: First Health Commercial |
$16,647.42
|
| Rate for Payer: Humana Commercial |
$14,895.06
|
| Rate for Payer: Humana KY Medicaid |
$6,026.37
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,420.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,142.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,278.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,432.32
|
| Rate for Payer: PHCS Commercial |
$16,822.66
|
| Rate for Payer: United Healthcare All Payer |
$15,420.77
|
|
|
DISCOVERY ELBOW ULNA 3*115M L
|
Facility
|
IP
|
$17,523.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.07 |
| Max. Negotiated Rate |
$16,822.66 |
| Rate for Payer: Aetna Commercial |
$13,493.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.41
|
| Rate for Payer: Cash Price |
$8,761.80
|
| Rate for Payer: Cigna Commercial |
$14,544.59
|
| Rate for Payer: First Health Commercial |
$16,647.42
|
| Rate for Payer: Humana Commercial |
$14,895.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,420.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,142.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,278.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,432.32
|
| Rate for Payer: PHCS Commercial |
$16,822.66
|
| Rate for Payer: United Healthcare All Payer |
$15,420.77
|
|
|
DISCOVERY ELBOW ULNA 3*115 R
|
Facility
|
OP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem Medicaid |
$6,142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Humana KY Medicaid |
$6,142.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,205.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,265.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
