|
ACCLAIM UNILINK ULNAR PLY 13MM
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem Medicaid |
$1,925.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Humana KY Medicaid |
$1,925.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
ACCLAIM UNILINK ULNAR PLY 13MM
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
ACCL ELBW HUM 150MM LG
|
Facility
|
IP
|
$28,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,598.75 |
| Max. Negotiated Rate |
$27,516.00 |
| Rate for Payer: Aetna Commercial |
$22,070.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,356.75
|
| Rate for Payer: Cash Price |
$14,331.25
|
| Rate for Payer: Cigna Commercial |
$23,789.88
|
| Rate for Payer: First Health Commercial |
$27,229.38
|
| Rate for Payer: Humana Commercial |
$24,363.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,503.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,152.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,598.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,223.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,936.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,777.12
|
| Rate for Payer: PHCS Commercial |
$27,516.00
|
| Rate for Payer: United Healthcare All Payer |
$25,223.00
|
|
|
ACCL ELBW HUM 150MM LG
|
Facility
|
OP
|
$28,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,598.75 |
| Max. Negotiated Rate |
$27,516.00 |
| Rate for Payer: Aetna Commercial |
$22,070.12
|
| Rate for Payer: Anthem Medicaid |
$9,857.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,356.75
|
| Rate for Payer: Cash Price |
$14,331.25
|
| Rate for Payer: Cigna Commercial |
$23,789.88
|
| Rate for Payer: First Health Commercial |
$27,229.38
|
| Rate for Payer: Humana Commercial |
$24,363.12
|
| Rate for Payer: Humana KY Medicaid |
$9,857.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,957.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,503.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,152.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,598.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,054.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,223.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,936.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,777.12
|
| Rate for Payer: PHCS Commercial |
$27,516.00
|
| Rate for Payer: United Healthcare All Payer |
$25,223.00
|
|
|
ACCL ELBW HUM 200MM LG
|
Facility
|
IP
|
$30,575.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,172.50 |
| Max. Negotiated Rate |
$29,352.00 |
| Rate for Payer: Aetna Commercial |
$23,542.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,848.50
|
| Rate for Payer: Cash Price |
$15,287.50
|
| Rate for Payer: Cigna Commercial |
$25,377.25
|
| Rate for Payer: First Health Commercial |
$29,046.25
|
| Rate for Payer: Humana Commercial |
$25,988.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,071.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,564.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,906.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,600.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,096.75
|
| Rate for Payer: PHCS Commercial |
$29,352.00
|
| Rate for Payer: United Healthcare All Payer |
$26,906.00
|
|
|
ACCL ELBW HUM 200MM LG
|
Facility
|
OP
|
$30,575.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,172.50 |
| Max. Negotiated Rate |
$29,352.00 |
| Rate for Payer: Aetna Commercial |
$23,542.75
|
| Rate for Payer: Anthem Medicaid |
$10,514.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,848.50
|
| Rate for Payer: Cash Price |
$15,287.50
|
| Rate for Payer: Cigna Commercial |
$25,377.25
|
| Rate for Payer: First Health Commercial |
$29,046.25
|
| Rate for Payer: Humana Commercial |
$25,988.75
|
| Rate for Payer: Humana KY Medicaid |
$10,514.74
|
| Rate for Payer: Kentucky WC Medicaid |
$10,621.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,071.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,564.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,172.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,725.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,906.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,600.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,096.75
|
| Rate for Payer: PHCS Commercial |
$29,352.00
|
| Rate for Payer: United Healthcare All Payer |
$26,906.00
|
|
|
ACCOLADE FEM HEAD V40 26MM +4
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 26MM +4
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 26MM STD
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
ACCOLADE FEM HEAD V40 26MM STD
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
ACCOLADE FEM HEAD V40 28MM 0
|
Facility
|
OP
|
$4,488.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.40 |
| Max. Negotiated Rate |
$4,308.49 |
| Rate for Payer: Aetna Commercial |
$3,455.77
|
| Rate for Payer: Anthem Medicaid |
$1,543.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.65
|
| Rate for Payer: Cash Price |
$2,244.01
|
| Rate for Payer: Cigna Commercial |
$3,725.05
|
| Rate for Payer: First Health Commercial |
$4,263.61
|
| Rate for Payer: Humana Commercial |
$3,814.81
|
| Rate for Payer: Humana KY Medicaid |
$1,543.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,559.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,574.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,366.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.73
|
| Rate for Payer: PHCS Commercial |
$4,308.49
|
| Rate for Payer: United Healthcare All Payer |
$3,949.45
|
|
|
ACCOLADE FEM HEAD V40 28MM 0
|
Facility
|
IP
|
$4,488.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.40 |
| Max. Negotiated Rate |
$4,308.49 |
| Rate for Payer: Aetna Commercial |
$3,455.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.65
|
| Rate for Payer: Cash Price |
$2,244.01
|
| Rate for Payer: Cigna Commercial |
$3,725.05
|
| Rate for Payer: First Health Commercial |
$4,263.61
|
| Rate for Payer: Humana Commercial |
$3,814.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,366.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.73
|
| Rate for Payer: PHCS Commercial |
$4,308.49
|
| Rate for Payer: United Healthcare All Payer |
$3,949.45
|
|
|
ACCOLADE FEM HEAD V40 28MM +12
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +12
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +16
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +16
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +4
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM +4
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM -4
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM -4
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM +6
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM +6
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
ACCOLADE FEM HEAD V40 28MM +8
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 28MM +8
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
ACCOLADE FEM HEAD V40 32MM 0
|
Facility
|
OP
|
$4,280.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.00 |
| Max. Negotiated Rate |
$4,108.80 |
| Rate for Payer: Aetna Commercial |
$3,295.60
|
| Rate for Payer: Anthem Medicaid |
$1,471.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.40
|
| Rate for Payer: Cash Price |
$2,140.00
|
| Rate for Payer: Cigna Commercial |
$3,552.40
|
| Rate for Payer: First Health Commercial |
$4,066.00
|
| Rate for Payer: Humana Commercial |
$3,638.00
|
| Rate for Payer: Humana KY Medicaid |
$1,471.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,486.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,509.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,158.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,766.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,723.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,953.20
|
| Rate for Payer: PHCS Commercial |
$4,108.80
|
| Rate for Payer: United Healthcare All Payer |
$3,766.40
|
|
