|
DIRECT REPAIR OF ANEURYSM - P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35141
|
| Hospital Charge Code |
76101365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$853.95 |
| Max. Negotiated Rate |
$1,966.33 |
| Rate for Payer: Aetna Commercial |
$1,966.33
|
| Rate for Payer: Ambetter Exchange |
$1,024.58
|
| Rate for Payer: Anthem Medicaid |
$853.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,024.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,024.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,229.50
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,887.69
|
| Rate for Payer: Healthspan PPO |
$1,933.29
|
| Rate for Payer: Humana Medicaid |
$853.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,519.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,024.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$871.03
|
| Rate for Payer: Molina Healthcare Passport |
$853.95
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,331.95
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$862.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,024.58
|
|
|
DIRECT REPAIR OF ANEURYSM - P
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 35091
|
| Hospital Charge Code |
76101360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
DIRECT REPAIR OF ANEURYSM - P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35132
|
| Hospital Charge Code |
76101364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$2,993.88 |
| Rate for Payer: Aetna Commercial |
$2,993.88
|
| Rate for Payer: Ambetter Exchange |
$1,538.68
|
| Rate for Payer: Anthem Medicaid |
$1,186.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,538.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,538.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,846.42
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,847.75
|
| Rate for Payer: Healthspan PPO |
$2,943.57
|
| Rate for Payer: Humana Medicaid |
$1,186.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,281.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,538.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,538.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,210.36
|
| Rate for Payer: Molina Healthcare Passport |
$1,186.63
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,000.28
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,198.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,538.68
|
|
|
DIRECT REPAIR OF ANEURYSM - P
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35132
|
| Hospital Charge Code |
76101364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR WITHOUT PATCH GRAFT; FOR ANEURYSM, PSEUDOANEURYSM, AND ASSOCIATED OCCLUSIVE DISEASE, RADIAL OR ULNAR ARTERY
|
Facility
|
OP
|
$6,992.66
|
|
|
Service Code
|
CPT 35045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
|
|
DISABILITY EXAMINATION/FORMS +
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99456
|
| Hospital Charge Code |
22200667
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.65
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
DISALCID(SALSALATE) 750MG/1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 10135040401
|
| Hospital Charge Code |
25000572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
DISALCID(SALSALATE) 750MG/1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 10135040401
|
| Hospital Charge Code |
25000572
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
DISARTICULATION FOOT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27889
|
| Hospital Charge Code |
76100961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
DISARTICULATION FOOT
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27889
|
| Hospital Charge Code |
76100961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.58 |
| Max. Negotiated Rate |
$1,122.76 |
| Rate for Payer: Aetna Commercial |
$1,028.93
|
| Rate for Payer: Ambetter Exchange |
$607.89
|
| Rate for Payer: Anthem Medicaid |
$522.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$607.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$729.47
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,122.76
|
| Rate for Payer: Healthspan PPO |
$931.99
|
| Rate for Payer: Humana Medicaid |
$522.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$872.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$607.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$533.03
|
| Rate for Payer: Molina Healthcare Passport |
$522.58
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$790.26
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$607.89
|
|
|
DISARTICULATION FOOT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27889
|
| Hospital Charge Code |
76100961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
DISARTICULATION FOOT(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27889
|
| Hospital Charge Code |
761P0961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.58 |
| Max. Negotiated Rate |
$1,122.76 |
| Rate for Payer: Aetna Commercial |
$1,028.93
|
| Rate for Payer: Ambetter Exchange |
$607.89
|
| Rate for Payer: Anthem Medicaid |
$522.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$607.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$729.47
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,122.76
|
| Rate for Payer: Healthspan PPO |
$931.99
|
| Rate for Payer: Humana Medicaid |
$522.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$872.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$607.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$533.03
|
| Rate for Payer: Molina Healthcare Passport |
$522.58
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$790.26
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$607.89
|
|
|
DISC CLIPS
|
Facility
|
OP
|
$1,802.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.82 |
| Max. Negotiated Rate |
$1,730.63 |
| Rate for Payer: Aetna Commercial |
$1,388.11
|
| Rate for Payer: Anthem Medicaid |
$619.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.14
|
| Rate for Payer: Cash Price |
$901.37
|
| Rate for Payer: Cigna Commercial |
$1,496.27
|
| Rate for Payer: First Health Commercial |
$1,712.60
|
| Rate for Payer: Humana Commercial |
$1,532.33
|
| Rate for Payer: Humana KY Medicaid |
$619.96
|
| Rate for Payer: Kentucky WC Medicaid |
$626.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,442.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.89
|
| Rate for Payer: PHCS Commercial |
$1,730.63
|
| Rate for Payer: United Healthcare All Payer |
$1,586.41
|
|
|
DISC CLIPS
|
Facility
|
IP
|
$1,802.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.82 |
| Max. Negotiated Rate |
$1,730.63 |
| Rate for Payer: Aetna Commercial |
$1,388.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.14
|
| Rate for Payer: Cash Price |
$901.37
|
| Rate for Payer: Cigna Commercial |
$1,496.27
|
| Rate for Payer: First Health Commercial |
$1,712.60
|
| Rate for Payer: Humana Commercial |
$1,532.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,442.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.89
|
| Rate for Payer: PHCS Commercial |
$1,730.63
|
| Rate for Payer: United Healthcare All Payer |
$1,586.41
|
|
|
DISCOVERY ELBOW 4*100MM LT HUM
|
Facility
|
OP
|
$16,828.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,048.49 |
| Max. Negotiated Rate |
$16,155.17 |
| Rate for Payer: Aetna Commercial |
$12,957.79
|
| Rate for Payer: Anthem Medicaid |
$5,787.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,126.07
|
| Rate for Payer: Cash Price |
$8,414.15
|
| Rate for Payer: Cigna Commercial |
$13,967.49
|
| Rate for Payer: First Health Commercial |
$15,986.89
|
| Rate for Payer: Humana Commercial |
$14,304.06
|
| Rate for Payer: Humana KY Medicaid |
$5,787.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,846.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,799.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,419.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,048.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,903.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,808.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,621.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,462.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,640.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,611.53
|
| Rate for Payer: PHCS Commercial |
$16,155.17
|
| Rate for Payer: United Healthcare All Payer |
$14,808.90
|
|
|
DISCOVERY ELBOW 4*100MM LT HUM
|
Facility
|
IP
|
$16,828.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,048.49 |
| Max. Negotiated Rate |
$16,155.17 |
| Rate for Payer: Aetna Commercial |
$12,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,126.07
|
| Rate for Payer: Cash Price |
$8,414.15
|
| Rate for Payer: Cigna Commercial |
$13,967.49
|
| Rate for Payer: First Health Commercial |
$15,986.89
|
| Rate for Payer: Humana Commercial |
$14,304.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,799.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,419.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,048.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,808.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,621.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,462.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,640.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,611.53
|
| Rate for Payer: PHCS Commercial |
$16,155.17
|
| Rate for Payer: United Healthcare All Payer |
$14,808.90
|
|
|
DISCOVERY ELBOW 4*100MM RT HUM
|
Facility
|
IP
|
$16,828.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,048.49 |
| Max. Negotiated Rate |
$16,155.17 |
| Rate for Payer: Aetna Commercial |
$12,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,126.07
|
| Rate for Payer: Cash Price |
$8,414.15
|
| Rate for Payer: Cigna Commercial |
$13,967.49
|
| Rate for Payer: First Health Commercial |
$15,986.89
|
| Rate for Payer: Humana Commercial |
$14,304.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,799.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,419.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,048.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,808.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,621.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,462.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,640.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,611.53
|
| Rate for Payer: PHCS Commercial |
$16,155.17
|
| Rate for Payer: United Healthcare All Payer |
$14,808.90
|
|
|
DISCOVERY ELBOW 4*100MM RT HUM
|
Facility
|
OP
|
$16,828.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,048.49 |
| Max. Negotiated Rate |
$16,155.17 |
| Rate for Payer: Aetna Commercial |
$12,957.79
|
| Rate for Payer: Anthem Medicaid |
$5,787.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,126.07
|
| Rate for Payer: Cash Price |
$8,414.15
|
| Rate for Payer: Cigna Commercial |
$13,967.49
|
| Rate for Payer: First Health Commercial |
$15,986.89
|
| Rate for Payer: Humana Commercial |
$14,304.06
|
| Rate for Payer: Humana KY Medicaid |
$5,787.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,846.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,799.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,419.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,048.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,903.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,808.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,621.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,462.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,640.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,611.53
|
| Rate for Payer: PHCS Commercial |
$16,155.17
|
| Rate for Payer: United Healthcare All Payer |
$14,808.90
|
|
|
DISCOVERY ELBOW 4*150MM LT HUM
|
Facility
|
IP
|
$17,331.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.45 |
| Max. Negotiated Rate |
$16,638.24 |
| Rate for Payer: Aetna Commercial |
$13,345.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,518.57
|
| Rate for Payer: Cash Price |
$8,665.75
|
| Rate for Payer: Cigna Commercial |
$14,385.15
|
| Rate for Payer: First Health Commercial |
$16,464.92
|
| Rate for Payer: Humana Commercial |
$14,731.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,211.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,790.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,199.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,251.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,998.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,865.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,078.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,958.74
|
| Rate for Payer: PHCS Commercial |
$16,638.24
|
| Rate for Payer: United Healthcare All Payer |
$15,251.72
|
|
|
DISCOVERY ELBOW 4*150MM LT HUM
|
Facility
|
OP
|
$17,331.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.45 |
| Max. Negotiated Rate |
$16,638.24 |
| Rate for Payer: Aetna Commercial |
$13,345.25
|
| Rate for Payer: Anthem Medicaid |
$5,960.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,518.57
|
| Rate for Payer: Cash Price |
$8,665.75
|
| Rate for Payer: Cigna Commercial |
$14,385.15
|
| Rate for Payer: First Health Commercial |
$16,464.92
|
| Rate for Payer: Humana Commercial |
$14,731.77
|
| Rate for Payer: Humana KY Medicaid |
$5,960.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,020.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,211.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,790.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,199.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,079.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,251.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,998.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,865.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,078.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,958.74
|
| Rate for Payer: PHCS Commercial |
$16,638.24
|
| Rate for Payer: United Healthcare All Payer |
$15,251.72
|
|
|
DISCOVERY ELBOW 4*150MM RT HUM
|
Facility
|
OP
|
$17,331.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.45 |
| Max. Negotiated Rate |
$16,638.24 |
| Rate for Payer: Aetna Commercial |
$13,345.25
|
| Rate for Payer: Anthem Medicaid |
$5,960.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,518.57
|
| Rate for Payer: Cash Price |
$8,665.75
|
| Rate for Payer: Cigna Commercial |
$14,385.15
|
| Rate for Payer: First Health Commercial |
$16,464.92
|
| Rate for Payer: Humana Commercial |
$14,731.77
|
| Rate for Payer: Humana KY Medicaid |
$5,960.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,020.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,211.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,790.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,199.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,079.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,251.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,998.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,865.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,078.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,958.74
|
| Rate for Payer: PHCS Commercial |
$16,638.24
|
| Rate for Payer: United Healthcare All Payer |
$15,251.72
|
|
|
DISCOVERY ELBOW 4*150MM RT HUM
|
Facility
|
IP
|
$17,331.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.45 |
| Max. Negotiated Rate |
$16,638.24 |
| Rate for Payer: Aetna Commercial |
$13,345.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,518.57
|
| Rate for Payer: Cash Price |
$8,665.75
|
| Rate for Payer: Cigna Commercial |
$14,385.15
|
| Rate for Payer: First Health Commercial |
$16,464.92
|
| Rate for Payer: Humana Commercial |
$14,731.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,211.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,790.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,199.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,251.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,998.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,865.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,078.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,958.74
|
| Rate for Payer: PHCS Commercial |
$16,638.24
|
| Rate for Payer: United Healthcare All Payer |
$15,251.72
|
|
|
DISCOVERY ELBOW 4*75MM RT ULNA
|
Facility
|
OP
|
$18,093.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,428.11 |
| Max. Negotiated Rate |
$17,369.95 |
| Rate for Payer: Aetna Commercial |
$13,932.15
|
| Rate for Payer: Anthem Medicaid |
$6,222.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,113.09
|
| Rate for Payer: Cash Price |
$9,046.85
|
| Rate for Payer: Cigna Commercial |
$15,017.77
|
| Rate for Payer: First Health Commercial |
$17,189.01
|
| Rate for Payer: Humana Commercial |
$15,379.65
|
| Rate for Payer: Humana KY Medicaid |
$6,222.42
|
| Rate for Payer: Kentucky WC Medicaid |
$6,285.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,836.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,353.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,428.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,347.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,922.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,570.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,741.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,484.65
|
| Rate for Payer: PHCS Commercial |
$17,369.95
|
| Rate for Payer: United Healthcare All Payer |
$15,922.46
|
|
|
DISCOVERY ELBOW 4*75MM RT ULNA
|
Facility
|
IP
|
$18,093.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,428.11 |
| Max. Negotiated Rate |
$17,369.95 |
| Rate for Payer: Aetna Commercial |
$13,932.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,113.09
|
| Rate for Payer: Cash Price |
$9,046.85
|
| Rate for Payer: Cigna Commercial |
$15,017.77
|
| Rate for Payer: First Health Commercial |
$17,189.01
|
| Rate for Payer: Humana Commercial |
$15,379.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,836.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,353.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,428.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,922.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,570.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,474.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,741.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,484.65
|
| Rate for Payer: PHCS Commercial |
$17,369.95
|
| Rate for Payer: United Healthcare All Payer |
$15,922.46
|
|
|
DISCOVERY ELBOW 5*100MM LT HUM
|
Facility
|
IP
|
$17,331.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.45 |
| Max. Negotiated Rate |
$16,638.24 |
| Rate for Payer: Aetna Commercial |
$13,345.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,518.57
|
| Rate for Payer: Cash Price |
$8,665.75
|
| Rate for Payer: Cigna Commercial |
$14,385.15
|
| Rate for Payer: First Health Commercial |
$16,464.92
|
| Rate for Payer: Humana Commercial |
$14,731.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,211.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,790.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,199.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,251.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,998.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,865.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,078.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,958.74
|
| Rate for Payer: PHCS Commercial |
$16,638.24
|
| Rate for Payer: United Healthcare All Payer |
$15,251.72
|
|
