|
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
|
|
|
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 |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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 +4
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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
|
| 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 |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| 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 |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
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 |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| 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 |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
|
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 |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
|
|
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 |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
ACCOLADE FEM HEAD V40 28MM +16
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
|
|
ACCOLADE FEM HEAD V40 28MM +16
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
ACCOLADE FEM HEAD V40 28MM +4
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +4
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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 28MM -4
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
ACCOLADE FEM HEAD V40 28MM -4
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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 28MM +6
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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 28MM +6
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +8
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
ACCOLADE FEM HEAD V40 28MM +8
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
|
|
ACCOLADE FEM HEAD V40 32MM 0
|
Facility
|
OP
|
$4,328.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$4,154.88 |
| Rate for Payer: Aetna Commercial |
$3,332.56
|
| Rate for Payer: Anthem Medicaid |
$1,488.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,375.84
|
| Rate for Payer: Cash Price |
$2,164.00
|
| Rate for Payer: Cigna Commercial |
$3,592.24
|
| Rate for Payer: First Health Commercial |
$4,111.60
|
| Rate for Payer: Humana Commercial |
$3,678.80
|
| Rate for Payer: Humana KY Medicaid |
$1,488.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,503.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,548.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,194.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,298.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,518.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,808.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,341.68
|
| Rate for Payer: PHCS Commercial |
$4,154.88
|
| Rate for Payer: United Healthcare All Payer |
$3,808.64
|
|
|
ACCOLADE FEM HEAD V40 32MM 0
|
Facility
|
IP
|
$4,328.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$4,154.88 |
| Rate for Payer: Aetna Commercial |
$3,332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,375.84
|
| Rate for Payer: Cash Price |
$2,164.00
|
| Rate for Payer: Cigna Commercial |
$3,592.24
|
| Rate for Payer: First Health Commercial |
$4,111.60
|
| Rate for Payer: Humana Commercial |
$3,678.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,548.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,194.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,298.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,808.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,341.68
|
| Rate for Payer: PHCS Commercial |
$4,154.88
|
| Rate for Payer: United Healthcare All Payer |
$3,808.64
|
|
|
ACCOLADE FEM HEAD V40 32MM +12
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
|
|
ACCOLADE FEM HEAD V40 32MM +12
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
ACCOLADE FEM HEAD V40 32MM +16
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
|
|
ACCOLADE FEM HEAD V40 32MM +16
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
