|
ACCLAIM ELBOW BOBBIN
|
Facility
IP
|
$11,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 HINGE OIN UNIT
|
Facility
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 RT 60MM LG
|
Facility
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 RT 60MM LG
|
Facility
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
ACCLAIM LINKED BEARING ASSEM
|
Facility
OP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 BEARING ASSEM
|
Facility
IP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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 |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| 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
|
|
|
ACCOLADE FEM HEAD V40 26MM +4
|
Facility
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
|
|
ACCOLADE FEM HEAD V40 26MM +4
|
Facility
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
ACCOLADE FEM HEAD V40 26MM STD
|
Facility
OP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem Medicaid |
$1,547.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Humana KY Medicaid |
$1,547.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
ACCOLADE FEM HEAD V40 26MM STD
|
Facility
IP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
|
|
ACCOLADE FEM HEAD V40 28MM 0
|
Facility
OP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem Medicaid |
$1,555.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Humana KY Medicaid |
$1,555.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,570.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,586.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
|
ACCOLADE FEM HEAD V40 28MM 0
|
Facility
IP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
|
|
ACCOLADE FEM HEAD V40 28MM +12
|
Facility
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
|
|
ACCOLADE FEM HEAD V40 28MM +12
|
Facility
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
