|
ACCOLADE FEM HEAD V40 32MM 0
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
ACCOLADE FEM HEAD V40 32MM +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 32MM +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 32MM +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 32MM +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 32MM +4
|
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 +4
|
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 32MM -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 32MM -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 32MM +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 +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 HIP STEM TMZF #1
|
Facility
|
IP
|
$22,061.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,618.30 |
| Max. Negotiated Rate |
$21,178.56 |
| Rate for Payer: Aetna Commercial |
$16,986.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,207.58
|
| Rate for Payer: Cash Price |
$11,030.50
|
| Rate for Payer: Cigna Commercial |
$18,310.63
|
| Rate for Payer: First Health Commercial |
$20,957.95
|
| Rate for Payer: Humana Commercial |
$18,751.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,090.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,281.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,618.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,413.68
|
| Rate for Payer: Ohio Health Group HMO |
$16,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,193.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,222.09
|
| Rate for Payer: PHCS Commercial |
$21,178.56
|
| Rate for Payer: United Healthcare All Payer |
$19,413.68
|
|
|
ACCOLADE HIP STEM TMZF #1
|
Facility
|
OP
|
$22,061.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,618.30 |
| Max. Negotiated Rate |
$21,178.56 |
| Rate for Payer: Aetna Commercial |
$16,986.97
|
| Rate for Payer: Anthem Medicaid |
$7,586.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,207.58
|
| Rate for Payer: Cash Price |
$11,030.50
|
| Rate for Payer: Cigna Commercial |
$18,310.63
|
| Rate for Payer: First Health Commercial |
$20,957.95
|
| Rate for Payer: Humana Commercial |
$18,751.85
|
| Rate for Payer: Humana KY Medicaid |
$7,586.78
|
| Rate for Payer: Kentucky WC Medicaid |
$7,663.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,090.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,281.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,618.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,739.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,413.68
|
| Rate for Payer: Ohio Health Group HMO |
$16,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,193.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,222.09
|
| Rate for Payer: PHCS Commercial |
$21,178.56
|
| Rate for Payer: United Healthcare All Payer |
$19,413.68
|
|
|
ACCOLADE TMZF HIP STEM #4.5
|
Facility
|
IP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
ACCOLADE TMZF HIP STEM #4.5
|
Facility
|
OP
|
$20,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,146.25 |
| Max. Negotiated Rate |
$19,668.00 |
| Rate for Payer: Aetna Commercial |
$15,775.38
|
| Rate for Payer: Anthem Medicaid |
$7,045.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,980.25
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna Commercial |
$17,004.62
|
| Rate for Payer: First Health Commercial |
$19,463.12
|
| Rate for Payer: Humana Commercial |
$17,414.38
|
| Rate for Payer: Humana KY Medicaid |
$7,045.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,117.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,799.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,146.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,187.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,029.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,824.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,136.38
|
| Rate for Payer: PHCS Commercial |
$19,668.00
|
| Rate for Payer: United Healthcare All Payer |
$18,029.00
|
|
|
ACCOLAD HIP STEM TMZF PLU #2.5
|
Facility
|
IP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
ACCOLAD HIP STEM TMZF PLU #2.5
|
Facility
|
OP
|
$21,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.75 |
| Max. Negotiated Rate |
$20,460.00 |
| Rate for Payer: Aetna Commercial |
$16,410.62
|
| Rate for Payer: Anthem Medicaid |
$7,329.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,623.75
|
| Rate for Payer: Cash Price |
$10,656.25
|
| Rate for Payer: Cigna Commercial |
$17,689.38
|
| Rate for Payer: First Health Commercial |
$20,246.88
|
| Rate for Payer: Humana Commercial |
$18,115.62
|
| Rate for Payer: Humana KY Medicaid |
$7,329.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,403.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,476.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,728.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,476.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,755.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,541.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,705.62
|
| Rate for Payer: PHCS Commercial |
$20,460.00
|
| Rate for Payer: United Healthcare All Payer |
$18,755.00
|
|
|
ACCOLAD HIP STEM TMZF PLU #3.5
|
Facility
|
IP
|
$23,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,029.60 |
| Max. Negotiated Rate |
$22,494.72 |
| Rate for Payer: Aetna Commercial |
$18,042.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,276.96
|
| Rate for Payer: Cash Price |
$11,716.00
|
| Rate for Payer: Cigna Commercial |
$19,448.56
|
| Rate for Payer: First Health Commercial |
$22,260.40
|
| Rate for Payer: Humana Commercial |
$19,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,214.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,292.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,620.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,385.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,168.08
|
| Rate for Payer: PHCS Commercial |
$22,494.72
|
| Rate for Payer: United Healthcare All Payer |
$20,620.16
|
|
|
ACCOLAD HIP STEM TMZF PLU #3.5
|
Facility
|
OP
|
$23,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,029.60 |
| Max. Negotiated Rate |
$22,494.72 |
| Rate for Payer: Aetna Commercial |
$18,042.64
|
| Rate for Payer: Anthem Medicaid |
$8,058.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,276.96
|
| Rate for Payer: Cash Price |
$11,716.00
|
| Rate for Payer: Cigna Commercial |
$19,448.56
|
| Rate for Payer: First Health Commercial |
$22,260.40
|
| Rate for Payer: Humana Commercial |
$19,917.20
|
| Rate for Payer: Humana KY Medicaid |
$8,058.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,140.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,214.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,292.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,219.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,620.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,385.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,168.08
|
| Rate for Payer: PHCS Commercial |
$22,494.72
|
| Rate for Payer: United Healthcare All Payer |
$20,620.16
|
|
|
ACCOLAD HIP STEM TMZF PLU #4.5
|
Facility
|
IP
|
$23,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,029.60 |
| Max. Negotiated Rate |
$22,494.72 |
| Rate for Payer: Aetna Commercial |
$18,042.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,276.96
|
| Rate for Payer: Cash Price |
$11,716.00
|
| Rate for Payer: Cigna Commercial |
$19,448.56
|
| Rate for Payer: First Health Commercial |
$22,260.40
|
| Rate for Payer: Humana Commercial |
$19,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,214.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,292.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,620.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,385.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,168.08
|
| Rate for Payer: PHCS Commercial |
$22,494.72
|
| Rate for Payer: United Healthcare All Payer |
$20,620.16
|
|
|
ACCOLAD HIP STEM TMZF PLU #4.5
|
Facility
|
OP
|
$23,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,029.60 |
| Max. Negotiated Rate |
$22,494.72 |
| Rate for Payer: Aetna Commercial |
$18,042.64
|
| Rate for Payer: Anthem Medicaid |
$8,058.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,276.96
|
| Rate for Payer: Cash Price |
$11,716.00
|
| Rate for Payer: Cigna Commercial |
$19,448.56
|
| Rate for Payer: First Health Commercial |
$22,260.40
|
| Rate for Payer: Humana Commercial |
$19,917.20
|
| Rate for Payer: Humana KY Medicaid |
$8,058.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,140.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,214.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,292.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,219.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,620.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,385.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,168.08
|
| Rate for Payer: PHCS Commercial |
$22,494.72
|
| Rate for Payer: United Healthcare All Payer |
$20,620.16
|
|
|
ACCOLAD HIP STEM TMZF PLU #5.5
|
Facility
|
OP
|
$22,721.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,816.30 |
| Max. Negotiated Rate |
$21,812.16 |
| Rate for Payer: Aetna Commercial |
$17,495.17
|
| Rate for Payer: Anthem Medicaid |
$7,813.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,722.38
|
| Rate for Payer: Cash Price |
$11,360.50
|
| Rate for Payer: Cigna Commercial |
$18,858.43
|
| Rate for Payer: First Health Commercial |
$21,584.95
|
| Rate for Payer: Humana Commercial |
$19,312.85
|
| Rate for Payer: Humana KY Medicaid |
$7,813.75
|
| Rate for Payer: Kentucky WC Medicaid |
$7,893.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,631.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,768.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,816.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,970.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,994.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,040.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,767.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,677.49
|
| Rate for Payer: PHCS Commercial |
$21,812.16
|
| Rate for Payer: United Healthcare All Payer |
$19,994.48
|
|
|
ACCOLAD HIP STEM TMZF PLU #5.5
|
Facility
|
IP
|
$22,721.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,816.30 |
| Max. Negotiated Rate |
$21,812.16 |
| Rate for Payer: Aetna Commercial |
$17,495.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,722.38
|
| Rate for Payer: Cash Price |
$11,360.50
|
| Rate for Payer: Cigna Commercial |
$18,858.43
|
| Rate for Payer: First Health Commercial |
$21,584.95
|
| Rate for Payer: Humana Commercial |
$19,312.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,631.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,768.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,816.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,994.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,040.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,767.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,677.49
|
| Rate for Payer: PHCS Commercial |
$21,812.16
|
| Rate for Payer: United Healthcare All Payer |
$19,994.48
|
|
|
ACCORD 150MM TITANIUM PLATE
|
Facility
|
IP
|
$4,685.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.61 |
| Max. Negotiated Rate |
$4,497.96 |
| Rate for Payer: Aetna Commercial |
$3,607.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.60
|
| Rate for Payer: Cash Price |
$2,342.69
|
| Rate for Payer: Cigna Commercial |
$3,888.87
|
| Rate for Payer: First Health Commercial |
$4,451.11
|
| Rate for Payer: Humana Commercial |
$3,982.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,842.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,123.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,514.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,748.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,076.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,232.91
|
| Rate for Payer: PHCS Commercial |
$4,497.96
|
| Rate for Payer: United Healthcare All Payer |
$4,123.13
|
|
|
ACCORD 150MM TITANIUM PLATE
|
Facility
|
OP
|
$4,685.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.61 |
| Max. Negotiated Rate |
$4,497.96 |
| Rate for Payer: Aetna Commercial |
$3,607.74
|
| Rate for Payer: Anthem Medicaid |
$1,611.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.60
|
| Rate for Payer: Cash Price |
$2,342.69
|
| Rate for Payer: Cigna Commercial |
$3,888.87
|
| Rate for Payer: First Health Commercial |
$4,451.11
|
| Rate for Payer: Humana Commercial |
$3,982.57
|
| Rate for Payer: Humana KY Medicaid |
$1,611.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,842.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,123.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,514.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,748.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,076.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,232.91
|
| Rate for Payer: PHCS Commercial |
$4,497.96
|
| Rate for Payer: United Healthcare All Payer |
$4,123.13
|
|
