|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
|
OP
|
$886.80
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
636T0220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$851.33 |
| Rate for Payer: Aetna Commercial |
$682.84
|
| Rate for Payer: Anthem Medicaid |
$304.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.70
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$736.04
|
| Rate for Payer: First Health Commercial |
$842.46
|
| Rate for Payer: Humana Commercial |
$753.78
|
| Rate for Payer: Humana KY Medicaid |
$304.97
|
| Rate for Payer: Kentucky WC Medicaid |
$308.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.38
|
| Rate for Payer: Ohio Health Group HMO |
$665.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.89
|
| Rate for Payer: PHCS Commercial |
$851.33
|
| Rate for Payer: United Healthcare All Payer |
$780.38
|
|
|
ABS BUTTON CONCVE 11MM/ IB
|
Facility
|
IP
|
$3,082.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.84 |
| Max. Negotiated Rate |
$2,959.50 |
| Rate for Payer: Aetna Commercial |
$2,373.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,404.59
|
| Rate for Payer: Cash Price |
$1,541.41
|
| Rate for Payer: Cigna Commercial |
$2,558.73
|
| Rate for Payer: First Health Commercial |
$2,928.67
|
| Rate for Payer: Humana Commercial |
$2,620.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,527.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$924.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,712.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,466.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.14
|
| Rate for Payer: PHCS Commercial |
$2,959.50
|
| Rate for Payer: United Healthcare All Payer |
$2,712.87
|
|
|
ABS BUTTON CONCVE 11MM/ IB
|
Facility
|
OP
|
$3,082.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.84 |
| Max. Negotiated Rate |
$2,959.50 |
| Rate for Payer: Aetna Commercial |
$2,373.76
|
| Rate for Payer: Anthem Medicaid |
$1,060.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,404.59
|
| Rate for Payer: Cash Price |
$1,541.41
|
| Rate for Payer: Cigna Commercial |
$2,558.73
|
| Rate for Payer: First Health Commercial |
$2,928.67
|
| Rate for Payer: Humana Commercial |
$2,620.39
|
| Rate for Payer: Humana KY Medicaid |
$1,060.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,070.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,527.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$924.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,081.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,712.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,466.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.14
|
| Rate for Payer: PHCS Commercial |
$2,959.50
|
| Rate for Payer: United Healthcare All Payer |
$2,712.87
|
|
|
ABS FIBERTAG
|
Facility
|
IP
|
$3,319.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.72 |
| Max. Negotiated Rate |
$3,186.30 |
| Rate for Payer: Aetna Commercial |
$2,555.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,588.87
|
| Rate for Payer: Cash Price |
$1,659.53
|
| Rate for Payer: Cigna Commercial |
$2,754.82
|
| Rate for Payer: First Health Commercial |
$3,153.11
|
| Rate for Payer: Humana Commercial |
$2,821.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,655.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,887.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.15
|
| Rate for Payer: PHCS Commercial |
$3,186.30
|
| Rate for Payer: United Healthcare All Payer |
$2,920.77
|
|
|
ABS FIBERTAG
|
Facility
|
OP
|
$3,319.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.72 |
| Max. Negotiated Rate |
$3,186.30 |
| Rate for Payer: Aetna Commercial |
$2,555.68
|
| Rate for Payer: Anthem Medicaid |
$1,141.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,588.87
|
| Rate for Payer: Cash Price |
$1,659.53
|
| Rate for Payer: Cigna Commercial |
$2,754.82
|
| Rate for Payer: First Health Commercial |
$3,153.11
|
| Rate for Payer: Humana Commercial |
$2,821.20
|
| Rate for Payer: Humana KY Medicaid |
$1,141.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,655.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,887.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.15
|
| Rate for Payer: PHCS Commercial |
$3,186.30
|
| Rate for Payer: United Healthcare All Payer |
$2,920.77
|
|
|
ACC ELBW ULNAR LT 60MM LG
|
Facility
|
IP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACC ELBW ULNAR LT 60MM LG
|
Facility
|
OP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACCLAIM ELBOW BOBBIN
|
Facility
|
IP
|
$11,977.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,593.31 |
| Max. Negotiated Rate |
$11,498.59 |
| Rate for Payer: Aetna Commercial |
$9,222.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,342.61
|
| Rate for Payer: Cash Price |
$5,988.85
|
| Rate for Payer: Cigna Commercial |
$9,941.49
|
| Rate for Payer: First Health Commercial |
$11,378.82
|
| Rate for Payer: Humana Commercial |
$10,181.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,821.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,839.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,593.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,540.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,983.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,582.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,264.61
|
| Rate for Payer: PHCS Commercial |
$11,498.59
|
| Rate for Payer: United Healthcare All Payer |
$10,540.38
|
|
|
ACCLAIM ELBOW BOBBIN
|
Facility
|
OP
|
$11,977.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,593.31 |
| Max. Negotiated Rate |
$11,498.59 |
| Rate for Payer: Aetna Commercial |
$9,222.83
|
| Rate for Payer: Anthem Medicaid |
$4,119.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,342.61
|
| Rate for Payer: Cash Price |
$5,988.85
|
| Rate for Payer: Cigna Commercial |
$9,941.49
|
| Rate for Payer: First Health Commercial |
$11,378.82
|
| Rate for Payer: Humana Commercial |
$10,181.05
|
| Rate for Payer: Humana KY Medicaid |
$4,119.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,161.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,821.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,839.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,593.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,201.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,540.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,983.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,582.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,264.61
|
| Rate for Payer: PHCS Commercial |
$11,498.59
|
| Rate for Payer: United Healthcare All Payer |
$10,540.38
|
|
|
ACCLAIM ELBOW HINGE OIN UNIT
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
ACCLAIM ELBOW HINGE OIN UNIT
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
ACCLAIM ELBOW ULNAR RT 85MM LG
|
Facility
|
IP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ACCLAIM ELBOW ULNAR RT 85MM LG
|
Facility
|
OP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem Medicaid |
$3,491.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Humana KY Medicaid |
$3,491.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
ACCL AIM ELBW HUM 100MM LG.
|
Facility
|
IP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
ACCL AIM ELBW HUM 100MM LG.
|
Facility
|
OP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem Medicaid |
$9,379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Humana KY Medicaid |
$9,379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,475.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,568.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
ACCLAIM ELBW ULNAR LT 85MM LG
|
Facility
|
IP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACCLAIM ELBW ULNAR LT 85MM LG
|
Facility
|
OP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACCLAIM ELBW ULNAR RT 60MM LG
|
Facility
|
IP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACCLAIM ELBW ULNAR RT 60MM LG
|
Facility
|
OP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
ACCLAIM LINKED BEARING ASSEM
|
Facility
|
OP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem Medicaid |
$4,813.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Humana KY Medicaid |
$4,813.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,862.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,909.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
ACCLAIM LINKED BEARING ASSEM
|
Facility
|
IP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
ACCLAIM LINKED POLY HUM YOKE
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
ACCLAIM LINKED POLY HUM YOKE
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
ACCLAIM UNILINK POLY 15MM
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
ACCLAIM UNILINK POLY 15MM
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem Medicaid |
$1,925.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Humana KY Medicaid |
$1,925.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
