|
ACC ELBW ULNAR LT 60MM LG
|
Facility
|
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACC ELBW ULNAR LT 60MM LG
|
Facility
|
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACCLAIM ELBOW BOBBIN
|
Facility
|
IP
|
$11,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.10 |
| Max. Negotiated Rate |
$11,262.24 |
| Rate for Payer: Aetna Commercial |
$9,033.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,150.57
|
| Rate for Payer: Cash Price |
$5,865.75
|
| Rate for Payer: Cigna Commercial |
$9,737.14
|
| Rate for Payer: First Health Commercial |
$11,144.92
|
| Rate for Payer: Humana Commercial |
$9,971.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,619.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,657.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,519.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,323.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,798.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.76
|
| Rate for Payer: PHCS Commercial |
$11,262.24
|
| Rate for Payer: United Healthcare All Payer |
$10,323.72
|
|
|
ACCLAIM ELBOW BOBBIN
|
Facility
|
OP
|
$11,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.10 |
| Max. Negotiated Rate |
$11,262.24 |
| Rate for Payer: Aetna Commercial |
$9,033.26
|
| Rate for Payer: Anthem Medicaid |
$4,034.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,150.57
|
| Rate for Payer: Cash Price |
$5,865.75
|
| Rate for Payer: Cigna Commercial |
$9,737.14
|
| Rate for Payer: First Health Commercial |
$11,144.92
|
| Rate for Payer: Humana Commercial |
$9,971.78
|
| Rate for Payer: Humana KY Medicaid |
$4,034.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,075.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,619.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,657.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,519.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,323.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,798.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.76
|
| Rate for Payer: PHCS Commercial |
$11,262.24
|
| Rate for Payer: United Healthcare All Payer |
$10,323.72
|
|
|
ACCLAIM ELBOW HINGE OIN UNIT
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
ACCLAIM ELBOW HINGE OIN UNIT
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
ACCLAIM ELBOW ULNAR RT 85MM LG
|
Facility
|
OP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem Medicaid |
$3,423.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Humana KY Medicaid |
$3,423.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
ACCLAIM ELBOW ULNAR RT 85MM LG
|
Facility
|
IP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
ACCL AIM ELBW HUM 100MM LG.
|
Facility
|
OP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem Medicaid |
$9,106.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Humana KY Medicaid |
$9,106.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,289.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
ACCL AIM ELBW HUM 100MM LG.
|
Facility
|
IP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
ACCLAIM ELBW ULNAR LT 85MM LG
|
Facility
|
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACCLAIM ELBW ULNAR LT 85MM LG
|
Facility
|
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACCLAIM ELBW ULNAR RT 60MM LG
|
Facility
|
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACCLAIM ELBW ULNAR RT 60MM LG
|
Facility
|
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACCLAIM LINKED BEARING ASSEM
|
Facility
|
IP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
ACCLAIM LINKED BEARING ASSEM
|
Facility
|
OP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem Medicaid |
$4,724.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Humana KY Medicaid |
$4,724.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,772.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
ACCLAIM LINKED POLY HUM YOKE
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
ACCLAIM LINKED POLY HUM YOKE
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
ACCLAIM UNILINK POLY 15MM
|
Facility
|
OP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem Medicaid |
$1,912.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Humana KY Medicaid |
$1,912.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,931.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,950.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
ACCLAIM UNILINK POLY 15MM
|
Facility
|
IP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
ACCLAIM UNILINK ULNAR PLY 13MM
|
Facility
|
OP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem Medicaid |
$1,912.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Humana KY Medicaid |
$1,912.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,931.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,950.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
ACCLAIM UNILINK ULNAR PLY 13MM
|
Facility
|
IP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
ACCL ELBW HUM 150MM LG
|
Facility
|
OP
|
$27,831.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,618.10 |
| Max. Negotiated Rate |
$26,718.24 |
| Rate for Payer: Aetna Commercial |
$21,430.26
|
| Rate for Payer: Anthem Medicaid |
$9,571.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,708.57
|
| Rate for Payer: Cash Price |
$13,915.75
|
| Rate for Payer: Cigna Commercial |
$23,100.14
|
| Rate for Payer: First Health Commercial |
$26,439.92
|
| Rate for Payer: Humana Commercial |
$23,656.78
|
| Rate for Payer: Humana KY Medicaid |
$9,571.25
|
| Rate for Payer: Kentucky WC Medicaid |
$9,668.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,821.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,539.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,349.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,763.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,491.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,873.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,566.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,618.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,627.76
|
| Rate for Payer: PHCS Commercial |
$26,718.24
|
| Rate for Payer: United Healthcare All Payer |
$24,491.72
|
|
|
ACCL ELBW HUM 150MM LG
|
Facility
|
IP
|
$27,831.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,618.10 |
| Max. Negotiated Rate |
$26,718.24 |
| Rate for Payer: Aetna Commercial |
$21,430.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,708.57
|
| Rate for Payer: Cash Price |
$13,915.75
|
| Rate for Payer: Cigna Commercial |
$23,100.14
|
| Rate for Payer: First Health Commercial |
$26,439.92
|
| Rate for Payer: Humana Commercial |
$23,656.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,821.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,539.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,349.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,491.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,873.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,566.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,618.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,627.76
|
| Rate for Payer: PHCS Commercial |
$26,718.24
|
| Rate for Payer: United Healthcare All Payer |
$24,491.72
|
|
|
ACCL ELBW HUM 200MM LG
|
Facility
|
IP
|
$29,693.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.09 |
| Max. Negotiated Rate |
$28,505.28 |
| Rate for Payer: Aetna Commercial |
$22,863.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,160.54
|
| Rate for Payer: Cash Price |
$14,846.50
|
| Rate for Payer: Cigna Commercial |
$24,645.19
|
| Rate for Payer: First Health Commercial |
$28,208.35
|
| Rate for Payer: Humana Commercial |
$25,239.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,907.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,129.84
|
| Rate for Payer: Ohio Health Group HMO |
$22,269.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,204.83
|
| Rate for Payer: PHCS Commercial |
$28,505.28
|
| Rate for Payer: United Healthcare All Payer |
$26,129.84
|
|
