|
SOFT TISSUE HEAD ULTRASOUND
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
SOFT TISSUE HEAD ULTRASOUND
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
SOFT TISSUE HEAD ULTRASOUND
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.47 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$166.82
|
| Rate for Payer: Anthem Medicaid |
$62.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$147.47
|
| Rate for Payer: Healthspan PPO |
$156.32
|
| Rate for Payer: Humana Medicaid |
$62.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.03
|
| Rate for Payer: Molina Healthcare Passport |
$62.77
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.40
|
|
|
SOFT TISSUE HEAD ULTRASOUND(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
402P0005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.47 |
| Max. Negotiated Rate |
$166.82 |
| Rate for Payer: Aetna Commercial |
$166.82
|
| Rate for Payer: Anthem Medicaid |
$62.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$147.47
|
| Rate for Payer: Healthspan PPO |
$156.32
|
| Rate for Payer: Humana Medicaid |
$62.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.03
|
| Rate for Payer: Molina Healthcare Passport |
$62.77
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.40
|
|
|
SOFT TISSUE HEAD ULTRASOUND(T
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
402T0005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.40
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
SOFT TISSUE HEAD ULTRASOUND(T
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
402T0005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem Medicaid |
$254.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Humana KY Medicaid |
$254.49
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$257.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$259.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.40
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$20,304.58
|
|
|
Service Code
|
MSDRG 501
|
| Min. Negotiated Rate |
$13,778.11 |
| Max. Negotiated Rate |
$20,304.58 |
| Rate for Payer: Anthem Medicaid |
$13,778.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,503.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,304.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,579.41
|
| Rate for Payer: Humana KY Medicaid |
$13,778.11
|
| Rate for Payer: Humana Medicare Advantage |
$14,503.27
|
| Rate for Payer: Kentucky WC Medicaid |
$13,915.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,403.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,053.67
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$37,934.95
|
|
|
Service Code
|
MSDRG 500
|
| Min. Negotiated Rate |
$25,741.57 |
| Max. Negotiated Rate |
$37,934.95 |
| Rate for Payer: Anthem Medicaid |
$25,741.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27,096.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,934.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,580.13
|
| Rate for Payer: Humana KY Medicaid |
$25,741.57
|
| Rate for Payer: Humana Medicare Advantage |
$27,096.39
|
| Rate for Payer: Kentucky WC Medicaid |
$25,998.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,515.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,256.40
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,175.10
|
|
|
Service Code
|
MSDRG 502
|
| Min. Negotiated Rate |
$10,975.96 |
| Max. Negotiated Rate |
$16,175.10 |
| Rate for Payer: Anthem Medicaid |
$10,975.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,553.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,175.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,597.41
|
| Rate for Payer: Humana KY Medicaid |
$10,975.96
|
| Rate for Payer: Humana Medicare Advantage |
$11,553.64
|
| Rate for Payer: Kentucky WC Medicaid |
$11,085.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,864.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,195.48
|
|
|
SOFT-VU SO1 5F 80CM
|
Facility
|
IP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
SOFT-VU SO1 5F 80CM
|
Facility
|
OP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem Medicaid |
$169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Humana KY Medicaid |
$169.78
|
| Rate for Payer: Kentucky WC Medicaid |
$171.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
SOLAR ELBOW AXLE PIN LRG
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SOLAR ELBOW AXLE PIN LRG
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SOLAR ELBOW AXLE PIN LRG RPL
|
Facility
|
IP
|
$9,113.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.70 |
| Max. Negotiated Rate |
$8,748.52 |
| Rate for Payer: Aetna Commercial |
$7,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.17
|
| Rate for Payer: Cash Price |
$4,556.52
|
| Rate for Payer: Cigna Commercial |
$7,563.82
|
| Rate for Payer: First Health Commercial |
$8,657.39
|
| Rate for Payer: Humana Commercial |
$7,746.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,472.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,733.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,019.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,834.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,822.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,184.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,825.04
|
| Rate for Payer: PHCS Commercial |
$8,748.52
|
| Rate for Payer: United Healthcare All Payer |
$8,019.48
|
|
|
SOLAR ELBOW AXLE PIN LRG RPL
|
Facility
|
OP
|
$9,113.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.70 |
| Max. Negotiated Rate |
$8,748.52 |
| Rate for Payer: Aetna Commercial |
$7,017.04
|
| Rate for Payer: Anthem Medicaid |
$3,133.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.17
|
| Rate for Payer: Cash Price |
$4,556.52
|
| Rate for Payer: Cigna Commercial |
$7,563.82
|
| Rate for Payer: First Health Commercial |
$8,657.39
|
| Rate for Payer: Humana Commercial |
$7,746.08
|
| Rate for Payer: Humana KY Medicaid |
$3,133.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,165.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,472.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,733.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,196.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,019.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,834.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,822.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,184.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,825.04
|
| Rate for Payer: PHCS Commercial |
$8,748.52
|
| Rate for Payer: United Healthcare All Payer |
$8,019.48
|
|
|
SOLAR HUMERAL HEAD 40*12
|
Facility
|
OP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem Medicaid |
$2,425.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Humana KY Medicaid |
$2,425.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
SOLAR HUMERAL HEAD 40*12
|
Facility
|
IP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
SOLAR HUMERAL HEAD 40*15
|
Facility
|
OP
|
$7,229.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.85 |
| Max. Negotiated Rate |
$6,940.45 |
| Rate for Payer: Aetna Commercial |
$5,566.82
|
| Rate for Payer: Anthem Medicaid |
$2,486.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,639.12
|
| Rate for Payer: Cash Price |
$3,614.82
|
| Rate for Payer: Cigna Commercial |
$6,000.60
|
| Rate for Payer: First Health Commercial |
$6,868.16
|
| Rate for Payer: Humana Commercial |
$6,145.19
|
| Rate for Payer: Humana KY Medicaid |
$2,486.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,511.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,928.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,335.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,536.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,362.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,422.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,241.19
|
| Rate for Payer: PHCS Commercial |
$6,940.45
|
| Rate for Payer: United Healthcare All Payer |
$6,362.08
|
|
|
SOLAR HUMERAL HEAD 40*15
|
Facility
|
IP
|
$7,229.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.85 |
| Max. Negotiated Rate |
$6,940.45 |
| Rate for Payer: Aetna Commercial |
$5,566.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,639.12
|
| Rate for Payer: Cash Price |
$3,614.82
|
| Rate for Payer: Cigna Commercial |
$6,000.60
|
| Rate for Payer: First Health Commercial |
$6,868.16
|
| Rate for Payer: Humana Commercial |
$6,145.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,928.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,335.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,362.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,422.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,241.19
|
| Rate for Payer: PHCS Commercial |
$6,940.45
|
| Rate for Payer: United Healthcare All Payer |
$6,362.08
|
|
|
SOLAR HUMERAL HEAD 40*18
|
Facility
|
OP
|
$6,928.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.75 |
| Max. Negotiated Rate |
$6,651.72 |
| Rate for Payer: Aetna Commercial |
$5,335.24
|
| Rate for Payer: Anthem Medicaid |
$2,382.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,404.53
|
| Rate for Payer: Cash Price |
$3,464.44
|
| Rate for Payer: Cigna Commercial |
$5,750.97
|
| Rate for Payer: First Health Commercial |
$6,582.44
|
| Rate for Payer: Humana Commercial |
$5,889.55
|
| Rate for Payer: Humana KY Medicaid |
$2,382.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,407.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,681.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,113.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,430.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,097.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,196.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$900.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,147.95
|
| Rate for Payer: PHCS Commercial |
$6,651.72
|
| Rate for Payer: United Healthcare All Payer |
$6,097.41
|
|
|
SOLAR HUMERAL HEAD 40*18
|
Facility
|
IP
|
$6,928.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.75 |
| Max. Negotiated Rate |
$6,651.72 |
| Rate for Payer: Aetna Commercial |
$5,335.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,404.53
|
| Rate for Payer: Cash Price |
$3,464.44
|
| Rate for Payer: Cigna Commercial |
$5,750.97
|
| Rate for Payer: First Health Commercial |
$6,582.44
|
| Rate for Payer: Humana Commercial |
$5,889.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,681.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,113.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,097.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,196.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$900.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,147.95
|
| Rate for Payer: PHCS Commercial |
$6,651.72
|
| Rate for Payer: United Healthcare All Payer |
$6,097.41
|
|
|
SOLAR HUMERAL HEAD 40*21
|
Facility
|
OP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem Medicaid |
$2,425.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Humana KY Medicaid |
$2,425.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
SOLAR HUMERAL HEAD 40*21
|
Facility
|
IP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
SOLAR HUMERAL HEAD 45*12
|
Facility
|
IP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
SOLAR HUMERAL HEAD 45*12
|
Facility
|
OP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem Medicaid |
$2,425.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Humana KY Medicaid |
$2,425.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
