|
SOLAR HUMERAL STEM SHLDR 9MM
|
Facility
|
OP
|
$13,146.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.01 |
| Max. Negotiated Rate |
$12,620.39 |
| Rate for Payer: Aetna Commercial |
$10,122.60
|
| Rate for Payer: Anthem Medicaid |
$4,520.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,254.07
|
| Rate for Payer: Cash Price |
$6,573.12
|
| Rate for Payer: Cigna Commercial |
$10,911.38
|
| Rate for Payer: First Health Commercial |
$12,488.93
|
| Rate for Payer: Humana Commercial |
$11,174.30
|
| Rate for Payer: Humana KY Medicaid |
$4,520.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,567.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,779.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,701.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,611.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,859.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,075.33
|
| Rate for Payer: PHCS Commercial |
$12,620.39
|
| Rate for Payer: United Healthcare All Payer |
$11,568.69
|
|
|
SOLAR HUMERAL STEM SHLDR 9MM
|
Facility
|
IP
|
$13,146.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.01 |
| Max. Negotiated Rate |
$12,620.39 |
| Rate for Payer: Aetna Commercial |
$10,122.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,254.07
|
| Rate for Payer: Cash Price |
$6,573.12
|
| Rate for Payer: Cigna Commercial |
$10,911.38
|
| Rate for Payer: First Health Commercial |
$12,488.93
|
| Rate for Payer: Humana Commercial |
$11,174.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,779.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,701.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,943.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,859.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,075.33
|
| Rate for Payer: PHCS Commercial |
$12,620.39
|
| Rate for Payer: United Healthcare All Payer |
$11,568.69
|
|
|
SOLAR HUMRL STEM SHOULD 11*200
|
Facility
|
IP
|
$16,330.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.97 |
| Max. Negotiated Rate |
$15,677.34 |
| Rate for Payer: Aetna Commercial |
$12,574.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,737.84
|
| Rate for Payer: Cash Price |
$8,165.28
|
| Rate for Payer: Cigna Commercial |
$13,554.36
|
| Rate for Payer: First Health Commercial |
$15,514.03
|
| Rate for Payer: Humana Commercial |
$13,880.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,391.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,051.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,899.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,370.89
|
| Rate for Payer: Ohio Health Group HMO |
$12,247.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,266.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,122.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,062.47
|
| Rate for Payer: PHCS Commercial |
$15,677.34
|
| Rate for Payer: United Healthcare All Payer |
$14,370.89
|
|
|
SOLAR HUMRL STEM SHOULD 11*200
|
Facility
|
OP
|
$16,330.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.97 |
| Max. Negotiated Rate |
$15,677.34 |
| Rate for Payer: Aetna Commercial |
$12,574.53
|
| Rate for Payer: Anthem Medicaid |
$5,616.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,737.84
|
| Rate for Payer: Cash Price |
$8,165.28
|
| Rate for Payer: Cigna Commercial |
$13,554.36
|
| Rate for Payer: First Health Commercial |
$15,514.03
|
| Rate for Payer: Humana Commercial |
$13,880.98
|
| Rate for Payer: Humana KY Medicaid |
$5,616.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5,673.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,391.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,051.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,899.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,728.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,370.89
|
| Rate for Payer: Ohio Health Group HMO |
$12,247.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,266.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,122.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,062.47
|
| Rate for Payer: PHCS Commercial |
$15,677.34
|
| Rate for Payer: United Healthcare All Payer |
$14,370.89
|
|
|
SOLAR HUMRL STEM SHOULD 13*200
|
Facility
|
IP
|
$15,069.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,958.99 |
| Max. Negotiated Rate |
$14,466.36 |
| Rate for Payer: Aetna Commercial |
$11,603.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,753.91
|
| Rate for Payer: Cash Price |
$7,534.56
|
| Rate for Payer: Cigna Commercial |
$12,507.37
|
| Rate for Payer: First Health Commercial |
$14,315.66
|
| Rate for Payer: Humana Commercial |
$12,808.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,356.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,121.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,520.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,260.83
|
| Rate for Payer: Ohio Health Group HMO |
$11,301.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,013.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,671.43
|
| Rate for Payer: PHCS Commercial |
$14,466.36
|
| Rate for Payer: United Healthcare All Payer |
$13,260.83
|
|
|
SOLAR HUMRL STEM SHOULD 13*200
|
Facility
|
OP
|
$15,069.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,958.99 |
| Max. Negotiated Rate |
$14,466.36 |
| Rate for Payer: Aetna Commercial |
$11,603.22
|
| Rate for Payer: Anthem Medicaid |
$5,182.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,753.91
|
| Rate for Payer: Cash Price |
$7,534.56
|
| Rate for Payer: Cigna Commercial |
$12,507.37
|
| Rate for Payer: First Health Commercial |
$14,315.66
|
| Rate for Payer: Humana Commercial |
$12,808.75
|
| Rate for Payer: Humana KY Medicaid |
$5,182.27
|
| Rate for Payer: Kentucky WC Medicaid |
$5,235.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,356.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,121.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,520.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,260.83
|
| Rate for Payer: Ohio Health Group HMO |
$11,301.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,013.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,671.43
|
| Rate for Payer: PHCS Commercial |
$14,466.36
|
| Rate for Payer: United Healthcare All Payer |
$13,260.83
|
|
|
SOLAR KEELED GLENOID SZ #5
|
Facility
|
OP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem Medicaid |
$2,561.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Humana KY Medicaid |
$2,561.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SOLAR KEELED GLENOID SZ #5
|
Facility
|
IP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SOLAR OFFSET HUM HEAD 40*15
|
Facility
|
OP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem Medicaid |
$2,708.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Humana KY Medicaid |
$2,708.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 40*15
|
Facility
|
IP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 40*18
|
Facility
|
OP
|
$7,670.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.17 |
| Max. Negotiated Rate |
$7,363.74 |
| Rate for Payer: Aetna Commercial |
$5,906.33
|
| Rate for Payer: Anthem Medicaid |
$2,637.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,983.04
|
| Rate for Payer: Cash Price |
$3,835.28
|
| Rate for Payer: Cigna Commercial |
$6,366.56
|
| Rate for Payer: First Health Commercial |
$7,287.03
|
| Rate for Payer: Humana Commercial |
$6,519.98
|
| Rate for Payer: Humana KY Medicaid |
$2,637.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,664.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,289.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,660.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,690.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,750.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,752.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,377.87
|
| Rate for Payer: PHCS Commercial |
$7,363.74
|
| Rate for Payer: United Healthcare All Payer |
$6,750.09
|
|
|
SOLAR OFFSET HUM HEAD 40*18
|
Facility
|
IP
|
$7,670.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.17 |
| Max. Negotiated Rate |
$7,363.74 |
| Rate for Payer: Aetna Commercial |
$5,906.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,983.04
|
| Rate for Payer: Cash Price |
$3,835.28
|
| Rate for Payer: Cigna Commercial |
$6,366.56
|
| Rate for Payer: First Health Commercial |
$7,287.03
|
| Rate for Payer: Humana Commercial |
$6,519.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,289.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,660.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,750.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,752.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,377.87
|
| Rate for Payer: PHCS Commercial |
$7,363.74
|
| Rate for Payer: United Healthcare All Payer |
$6,750.09
|
|
|
SOLAR OFFSET HUM HEAD 45*15
|
Facility
|
IP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 45*15
|
Facility
|
OP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem Medicaid |
$2,708.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Humana KY Medicaid |
$2,708.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 45*18
|
Facility
|
OP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem Medicaid |
$2,708.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Humana KY Medicaid |
$2,708.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 45*18
|
Facility
|
IP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOLAR OFFSET HUM HEAD 45*21
|
Facility
|
OP
|
$7,483.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.88 |
| Max. Negotiated Rate |
$7,184.33 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Anthem Medicaid |
$2,573.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,837.27
|
| Rate for Payer: Cash Price |
$3,741.84
|
| Rate for Payer: Cigna Commercial |
$6,211.45
|
| Rate for Payer: First Health Commercial |
$7,109.50
|
| Rate for Payer: Humana Commercial |
$6,361.13
|
| Rate for Payer: Humana KY Medicaid |
$2,573.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,599.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,136.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,522.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,245.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,625.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,585.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,612.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.94
|
| Rate for Payer: PHCS Commercial |
$7,184.33
|
| Rate for Payer: United Healthcare All Payer |
$6,585.64
|
|
|
SOLAR OFFSET HUM HEAD 45*21
|
Facility
|
IP
|
$7,483.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.88 |
| Max. Negotiated Rate |
$7,184.33 |
| Rate for Payer: Aetna Commercial |
$5,762.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,837.27
|
| Rate for Payer: Cash Price |
$3,741.84
|
| Rate for Payer: Cigna Commercial |
$6,211.45
|
| Rate for Payer: First Health Commercial |
$7,109.50
|
| Rate for Payer: Humana Commercial |
$6,361.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,136.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,522.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,245.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,585.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,612.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.94
|
| Rate for Payer: PHCS Commercial |
$7,184.33
|
| Rate for Payer: United Healthcare All Payer |
$6,585.64
|
|
|
SOLAR OFFSET HUM HEAD 50*21
|
Facility
|
IP
|
$7,136.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.71 |
| Max. Negotiated Rate |
$6,850.75 |
| Rate for Payer: Aetna Commercial |
$5,494.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,566.24
|
| Rate for Payer: Cash Price |
$3,568.10
|
| Rate for Payer: Cigna Commercial |
$5,923.05
|
| Rate for Payer: First Health Commercial |
$6,779.39
|
| Rate for Payer: Humana Commercial |
$6,065.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,266.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,352.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,427.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.22
|
| Rate for Payer: PHCS Commercial |
$6,850.75
|
| Rate for Payer: United Healthcare All Payer |
$6,279.86
|
|
|
SOLAR OFFSET HUM HEAD 50*21
|
Facility
|
OP
|
$7,136.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.71 |
| Max. Negotiated Rate |
$6,850.75 |
| Rate for Payer: Aetna Commercial |
$5,494.87
|
| Rate for Payer: Anthem Medicaid |
$2,454.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,566.24
|
| Rate for Payer: Cash Price |
$3,568.10
|
| Rate for Payer: Cigna Commercial |
$5,923.05
|
| Rate for Payer: First Health Commercial |
$6,779.39
|
| Rate for Payer: Humana Commercial |
$6,065.77
|
| Rate for Payer: Humana KY Medicaid |
$2,454.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,479.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,266.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,503.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,352.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,427.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.22
|
| Rate for Payer: PHCS Commercial |
$6,850.75
|
| Rate for Payer: United Healthcare All Payer |
$6,279.86
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +0
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem Medicaid |
$1,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Humana KY Medicaid |
$1,608.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +0
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +2
|
Facility
|
IP
|
$4,406.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.83 |
| Max. Negotiated Rate |
$4,230.14 |
| Rate for Payer: Aetna Commercial |
$3,392.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.99
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Cigna Commercial |
$3,657.31
|
| Rate for Payer: First Health Commercial |
$4,186.08
|
| Rate for Payer: Humana Commercial |
$3,745.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,613.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.98
|
| Rate for Payer: PHCS Commercial |
$4,230.14
|
| Rate for Payer: United Healthcare All Payer |
$3,877.63
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +2
|
Facility
|
OP
|
$4,406.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.83 |
| Max. Negotiated Rate |
$4,230.14 |
| Rate for Payer: Aetna Commercial |
$3,392.93
|
| Rate for Payer: Anthem Medicaid |
$1,515.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.99
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Cigna Commercial |
$3,657.31
|
| Rate for Payer: First Health Commercial |
$4,186.08
|
| Rate for Payer: Humana Commercial |
$3,745.44
|
| Rate for Payer: Humana KY Medicaid |
$1,515.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,530.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,613.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,545.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.98
|
| Rate for Payer: PHCS Commercial |
$4,230.14
|
| Rate for Payer: United Healthcare All Payer |
$3,877.63
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +4
|
Facility
|
IP
|
$4,232.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.26 |
| Max. Negotiated Rate |
$4,063.49 |
| Rate for Payer: Aetna Commercial |
$3,259.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,301.58
|
| Rate for Payer: Cash Price |
$2,116.40
|
| Rate for Payer: Cigna Commercial |
$3,513.22
|
| Rate for Payer: First Health Commercial |
$4,021.16
|
| Rate for Payer: Humana Commercial |
$3,597.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,470.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,123.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,724.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,174.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.17
|
| Rate for Payer: PHCS Commercial |
$4,063.49
|
| Rate for Payer: United Healthcare All Payer |
$3,724.86
|
|
