|
ACCOLADE FEM HEAD V40 32MM +4
|
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 +4
|
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 -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 32MM -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 32MM +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 +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 HIP STEM TMZF #1
|
Facility
|
IP
|
$21,406.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,782.79 |
| Max. Negotiated Rate |
$20,549.80 |
| Rate for Payer: Aetna Commercial |
$16,482.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,696.71
|
| Rate for Payer: Cash Price |
$10,703.02
|
| Rate for Payer: Cigna Commercial |
$17,767.01
|
| Rate for Payer: First Health Commercial |
$20,335.74
|
| Rate for Payer: Humana Commercial |
$18,195.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,552.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,797.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,421.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,837.32
|
| Rate for Payer: Ohio Health Group HMO |
$16,054.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,281.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,635.87
|
| Rate for Payer: PHCS Commercial |
$20,549.80
|
| Rate for Payer: United Healthcare All Payer |
$18,837.32
|
|
|
ACCOLADE HIP STEM TMZF #1
|
Facility
|
OP
|
$21,406.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,782.79 |
| Max. Negotiated Rate |
$20,549.80 |
| Rate for Payer: Aetna Commercial |
$16,482.65
|
| Rate for Payer: Anthem Medicaid |
$7,361.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,696.71
|
| Rate for Payer: Cash Price |
$10,703.02
|
| Rate for Payer: Cigna Commercial |
$17,767.01
|
| Rate for Payer: First Health Commercial |
$20,335.74
|
| Rate for Payer: Humana Commercial |
$18,195.13
|
| Rate for Payer: Humana KY Medicaid |
$7,361.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,436.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,552.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,797.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,421.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,509.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,837.32
|
| Rate for Payer: Ohio Health Group HMO |
$16,054.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,281.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,635.87
|
| Rate for Payer: PHCS Commercial |
$20,549.80
|
| Rate for Payer: United Healthcare All Payer |
$18,837.32
|
|
|
ACCOLADE TMZF HIP STEM #4.5
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
ACCOLADE TMZF HIP STEM #4.5
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
ACCOLAD HIP STEM TMZF PLU #2.5
|
Facility
|
IP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
ACCOLAD HIP STEM TMZF PLU #2.5
|
Facility
|
OP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem Medicaid |
$7,110.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Humana KY Medicaid |
$7,110.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
ACCOLAD HIP STEM TMZF PLU #3.5
|
Facility
|
OP
|
$22,740.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.26 |
| Max. Negotiated Rate |
$21,830.86 |
| Rate for Payer: Aetna Commercial |
$17,510.17
|
| Rate for Payer: Anthem Medicaid |
$7,820.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,737.57
|
| Rate for Payer: Cash Price |
$11,370.24
|
| Rate for Payer: Cigna Commercial |
$18,874.60
|
| Rate for Payer: First Health Commercial |
$21,603.46
|
| Rate for Payer: Humana Commercial |
$19,329.41
|
| Rate for Payer: Humana KY Medicaid |
$7,820.45
|
| Rate for Payer: Kentucky WC Medicaid |
$7,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,647.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,822.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,977.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,011.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,055.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,049.55
|
| Rate for Payer: PHCS Commercial |
$21,830.86
|
| Rate for Payer: United Healthcare All Payer |
$20,011.62
|
|
|
ACCOLAD HIP STEM TMZF PLU #3.5
|
Facility
|
IP
|
$22,740.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.26 |
| Max. Negotiated Rate |
$21,830.86 |
| Rate for Payer: Aetna Commercial |
$17,510.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,737.57
|
| Rate for Payer: Cash Price |
$11,370.24
|
| Rate for Payer: Cigna Commercial |
$18,874.60
|
| Rate for Payer: First Health Commercial |
$21,603.46
|
| Rate for Payer: Humana Commercial |
$19,329.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,647.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,822.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,011.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,055.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,049.55
|
| Rate for Payer: PHCS Commercial |
$21,830.86
|
| Rate for Payer: United Healthcare All Payer |
$20,011.62
|
|
|
ACCOLAD HIP STEM TMZF PLU #4.5
|
Facility
|
IP
|
$22,740.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.26 |
| Max. Negotiated Rate |
$21,830.86 |
| Rate for Payer: Aetna Commercial |
$17,510.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,737.57
|
| Rate for Payer: Cash Price |
$11,370.24
|
| Rate for Payer: Cigna Commercial |
$18,874.60
|
| Rate for Payer: First Health Commercial |
$21,603.46
|
| Rate for Payer: Humana Commercial |
$19,329.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,647.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,822.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,011.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,055.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,049.55
|
| Rate for Payer: PHCS Commercial |
$21,830.86
|
| Rate for Payer: United Healthcare All Payer |
$20,011.62
|
|
|
ACCOLAD HIP STEM TMZF PLU #4.5
|
Facility
|
OP
|
$22,740.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.26 |
| Max. Negotiated Rate |
$21,830.86 |
| Rate for Payer: Aetna Commercial |
$17,510.17
|
| Rate for Payer: Anthem Medicaid |
$7,820.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,737.57
|
| Rate for Payer: Cash Price |
$11,370.24
|
| Rate for Payer: Cigna Commercial |
$18,874.60
|
| Rate for Payer: First Health Commercial |
$21,603.46
|
| Rate for Payer: Humana Commercial |
$19,329.41
|
| Rate for Payer: Humana KY Medicaid |
$7,820.45
|
| Rate for Payer: Kentucky WC Medicaid |
$7,900.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,647.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,822.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,977.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,011.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,055.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,049.55
|
| Rate for Payer: PHCS Commercial |
$21,830.86
|
| Rate for Payer: United Healthcare All Payer |
$20,011.62
|
|
|
ACCOLAD HIP STEM TMZF PLU #5.5
|
Facility
|
IP
|
$22,048.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.30 |
| Max. Negotiated Rate |
$21,166.50 |
| Rate for Payer: Aetna Commercial |
$16,977.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,197.78
|
| Rate for Payer: Cash Price |
$11,024.22
|
| Rate for Payer: Cigna Commercial |
$18,300.21
|
| Rate for Payer: First Health Commercial |
$20,946.02
|
| Rate for Payer: Humana Commercial |
$18,741.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,079.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,271.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,402.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,536.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,835.02
|
| Rate for Payer: PHCS Commercial |
$21,166.50
|
| Rate for Payer: United Healthcare All Payer |
$19,402.63
|
|
|
ACCOLAD HIP STEM TMZF PLU #5.5
|
Facility
|
OP
|
$22,048.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.30 |
| Max. Negotiated Rate |
$21,166.50 |
| Rate for Payer: Aetna Commercial |
$16,977.30
|
| Rate for Payer: Anthem Medicaid |
$7,582.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,197.78
|
| Rate for Payer: Cash Price |
$11,024.22
|
| Rate for Payer: Cigna Commercial |
$18,300.21
|
| Rate for Payer: First Health Commercial |
$20,946.02
|
| Rate for Payer: Humana Commercial |
$18,741.17
|
| Rate for Payer: Humana KY Medicaid |
$7,582.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,659.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,079.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,271.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,734.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,402.63
|
| Rate for Payer: Ohio Health Group HMO |
$16,536.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,835.02
|
| Rate for Payer: PHCS Commercial |
$21,166.50
|
| Rate for Payer: United Healthcare All Payer |
$19,402.63
|
|
|
ACCORD 150MM TITANIUM PLATE
|
Facility
|
OP
|
$4,706.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.83 |
| Max. Negotiated Rate |
$4,518.10 |
| Rate for Payer: Humana Commercial |
$4,000.40
|
| Rate for Payer: Humana KY Medicaid |
$1,618.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,859.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,473.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,141.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,529.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,458.97
|
| Rate for Payer: PHCS Commercial |
$4,518.10
|
| Rate for Payer: United Healthcare All Payer |
$4,141.59
|
| Rate for Payer: Aetna Commercial |
$3,623.89
|
| Rate for Payer: Anthem Medicaid |
$1,618.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,670.95
|
| Rate for Payer: Cash Price |
$2,353.18
|
| Rate for Payer: Cigna Commercial |
$3,906.27
|
| Rate for Payer: First Health Commercial |
$4,471.03
|
|
|
ACCORD 150MM TITANIUM PLATE
|
Facility
|
IP
|
$4,706.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.83 |
| Max. Negotiated Rate |
$4,518.10 |
| Rate for Payer: Aetna Commercial |
$3,623.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,670.95
|
| Rate for Payer: Cash Price |
$2,353.18
|
| Rate for Payer: Cigna Commercial |
$3,906.27
|
| Rate for Payer: First Health Commercial |
$4,471.03
|
| Rate for Payer: Humana Commercial |
$4,000.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,859.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,473.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,141.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,529.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,458.97
|
| Rate for Payer: PHCS Commercial |
$4,518.10
|
| Rate for Payer: United Healthcare All Payer |
$4,141.59
|
|
|
ACCORD 200MM TITANIUM PLATE
|
Facility
|
OP
|
$5,295.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.40 |
| Max. Negotiated Rate |
$5,083.58 |
| Rate for Payer: Aetna Commercial |
$4,077.46
|
| Rate for Payer: Anthem Medicaid |
$1,821.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,130.41
|
| Rate for Payer: Cash Price |
$2,647.70
|
| Rate for Payer: Cigna Commercial |
$4,395.18
|
| Rate for Payer: First Health Commercial |
$5,030.63
|
| Rate for Payer: Humana Commercial |
$4,501.09
|
| Rate for Payer: Humana KY Medicaid |
$1,821.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,839.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,342.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,908.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,857.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,659.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,971.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,059.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.57
|
| Rate for Payer: PHCS Commercial |
$5,083.58
|
| Rate for Payer: United Healthcare All Payer |
$4,659.95
|
|
|
ACCORD 200MM TITANIUM PLATE
|
Facility
|
IP
|
$5,295.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.40 |
| Max. Negotiated Rate |
$5,083.58 |
| Rate for Payer: Aetna Commercial |
$4,077.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,130.41
|
| Rate for Payer: Cash Price |
$2,647.70
|
| Rate for Payer: Cigna Commercial |
$4,395.18
|
| Rate for Payer: First Health Commercial |
$5,030.63
|
| Rate for Payer: Humana Commercial |
$4,501.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,342.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,908.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,659.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,971.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,059.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.57
|
| Rate for Payer: PHCS Commercial |
$5,083.58
|
| Rate for Payer: United Healthcare All Payer |
$4,659.95
|
|
|
ACCORD 250MM TITANIUM PLATE
|
Facility
|
OP
|
$7,027.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.55 |
| Max. Negotiated Rate |
$6,746.23 |
| Rate for Payer: Aetna Commercial |
$5,411.04
|
| Rate for Payer: Anthem Medicaid |
$2,416.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.31
|
| Rate for Payer: Cash Price |
$3,513.66
|
| Rate for Payer: Cigna Commercial |
$5,832.68
|
| Rate for Payer: First Health Commercial |
$6,675.95
|
| Rate for Payer: Humana Commercial |
$5,973.22
|
| Rate for Payer: Humana KY Medicaid |
$2,416.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.47
|
| Rate for Payer: PHCS Commercial |
$6,746.23
|
| Rate for Payer: United Healthcare All Payer |
$6,184.04
|
|
|
ACCORD 250MM TITANIUM PLATE
|
Facility
|
IP
|
$7,027.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.55 |
| Max. Negotiated Rate |
$6,746.23 |
| Rate for Payer: Aetna Commercial |
$5,411.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.31
|
| Rate for Payer: Cash Price |
$3,513.66
|
| Rate for Payer: Cigna Commercial |
$5,832.68
|
| Rate for Payer: First Health Commercial |
$6,675.95
|
| Rate for Payer: Humana Commercial |
$5,973.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.47
|
| Rate for Payer: PHCS Commercial |
$6,746.23
|
| Rate for Payer: United Healthcare All Payer |
$6,184.04
|
|
|
ACCORD GUIDEWIRE .040 (1.02M)
|
Facility
|
IP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
