|
DISCOVERY ELBOW 5*100MM 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 5*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 5*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 5*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 5*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 6*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
|
|
|
DISCOVERY ELBOW 6*100MM 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 6*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 6*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 6*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 6*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 6*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 6*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 HUM FLNG 5*100
|
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 HUM FLNG 5*100
|
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 ULNA 3*115M L
|
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 ULNA 3*115M L
|
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 ULNA 3*115 R
|
Facility
|
OP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem Medicaid |
$6,342.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Humana KY Medicaid |
$6,342.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,406.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,469.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
DISCOVERY ELBOW ULNA 3*115 R
|
Facility
|
IP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
DISCOVERY ELBOW ULNA 3*75 L
|
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 ULNA 3*75 L
|
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 ULNA 3*75 R
|
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 ULNA 3*75 R
|
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 ULNA 4*115 L
|
Facility
|
OP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem Medicaid |
$6,342.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Humana KY Medicaid |
$6,342.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,406.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,469.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
DISCOVERY ELBOW ULNA 4*115 L
|
Facility
|
IP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
