|
DISCOVERY ELBOW ULNA 3*115 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 3*75 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*75 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*75 R
|
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*75 R
|
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 4*115 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 4*115 L
|
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
|
|
|
DISCOVERY ELBOW ULNA 4*115 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 4*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
|
|
|
DISCOVERY ELBOW ULNA 4*75 L
|
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
|
|
|
DISCOVERY ELBOW ULNA 4*75 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 5*115 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 5*115 L
|
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
|
|
|
DISCOVERY ELBOW ULNA 5*115 R
|
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 5*115 R
|
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 5*75 L
|
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
|
|
|
DISCOVERY ELBOW ULNA 5*75 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DISCOVERY ELBOW ULNA 5*75 R
|
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 5*75 R
|
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 ELBW HUM CONDYLE SET
|
Facility
|
IP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
DISCOVERY ELBW HUM CONDYLE SET
|
Facility
|
OP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem Medicaid |
$4,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Humana KY Medicaid |
$4,015.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,056.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,096.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
DISCOVISC
|
Facility
|
IP
|
$897.69
|
|
|
Service Code
|
NDC 8065183710
|
| Hospital Charge Code |
25003025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$861.78 |
| Rate for Payer: Aetna Commercial |
$691.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.20
|
| Rate for Payer: Cash Price |
$448.85
|
| Rate for Payer: Cigna Commercial |
$745.08
|
| Rate for Payer: First Health Commercial |
$852.81
|
| Rate for Payer: Humana Commercial |
$763.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.97
|
| Rate for Payer: Ohio Health Group HMO |
$673.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.28
|
| Rate for Payer: PHCS Commercial |
$861.78
|
| Rate for Payer: United Healthcare All Payer |
$789.97
|
|
|
DISCOVISC
|
Facility
|
OP
|
$897.69
|
|
|
Service Code
|
NDC 8065183710
|
| Hospital Charge Code |
25003025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$861.78 |
| Rate for Payer: Aetna Commercial |
$691.22
|
| Rate for Payer: Anthem Medicaid |
$308.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.20
|
| Rate for Payer: Cash Price |
$448.85
|
| Rate for Payer: Cigna Commercial |
$745.08
|
| Rate for Payer: First Health Commercial |
$852.81
|
| Rate for Payer: Humana Commercial |
$763.04
|
| Rate for Payer: Humana KY Medicaid |
$308.72
|
| Rate for Payer: Kentucky WC Medicaid |
$311.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$314.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.97
|
| Rate for Payer: Ohio Health Group HMO |
$673.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.28
|
| Rate for Payer: PHCS Commercial |
$861.78
|
| Rate for Payer: United Healthcare All Payer |
$789.97
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$11,130.84
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$7,553.07 |
| Max. Negotiated Rate |
$11,130.84 |
| Rate for Payer: Anthem Medicaid |
$7,553.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,950.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,130.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,733.31
|
| Rate for Payer: Humana KY Medicaid |
$7,553.07
|
| Rate for Payer: Humana Medicare Advantage |
$7,950.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,628.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,540.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.13
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$21,386.65
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$14,512.37 |
| Max. Negotiated Rate |
$21,386.65 |
| Rate for Payer: Anthem Medicaid |
$14,512.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,276.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,386.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,622.84
|
| Rate for Payer: Humana KY Medicaid |
$14,512.37
|
| Rate for Payer: Humana Medicare Advantage |
$15,276.18
|
| Rate for Payer: Kentucky WC Medicaid |
$14,657.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,331.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,802.62
|
|
