|
SODIUM THIOSULFATE 25% VL(50ML
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002464
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
SOD POLYSTYRENE SULF 15GM PWDR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 10702003615
|
| Hospital Charge Code |
25003473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.16
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
SOD POLYSTYRENE SULF 15GM PWDR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 10702003615
|
| Hospital Charge Code |
25003473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$41.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.16
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$41.96
|
| Rate for Payer: Kentucky WC Medicaid |
$42.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
SOFT TISSUE HEAD ULTRASOUND
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$876.48 |
| Rate for Payer: Aetna Commercial |
$703.01
|
| Rate for Payer: Anthem Medicaid |
$313.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$712.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: First Health Commercial |
$867.35
|
| Rate for Payer: Humana Commercial |
$776.05
|
| Rate for Payer: Humana KY Medicaid |
$313.98
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$317.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$748.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$673.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$803.44
|
| Rate for Payer: Ohio Health Group HMO |
$684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$794.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.97
|
| Rate for Payer: PHCS Commercial |
$876.48
|
| Rate for Payer: United Healthcare All Payer |
$803.44
|
|
|
SOFT TISSUE HEAD ULTRASOUND
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.47 |
| Max. Negotiated Rate |
$547.80 |
| Rate for Payer: Aetna Commercial |
$166.82
|
| Rate for Payer: Ambetter Exchange |
$98.46
|
| Rate for Payer: Anthem Medicaid |
$62.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.15
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna Commercial |
$147.47
|
| Rate for Payer: Healthspan PPO |
$156.31
|
| Rate for Payer: Humana Medicaid |
$62.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.03
|
| Rate for Payer: Molina Healthcare Passport |
$62.77
|
| Rate for Payer: Multiplan PHCS |
$547.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.00
|
| Rate for Payer: UHCCP Medicaid |
$319.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.46
|
|
|
SOFT TISSUE HEAD ULTRASOUND
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.90 |
| Max. Negotiated Rate |
$876.48 |
| Rate for Payer: Aetna Commercial |
$703.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$712.14
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: First Health Commercial |
$867.35
|
| Rate for Payer: Humana Commercial |
$776.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$748.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$673.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$803.44
|
| Rate for Payer: Ohio Health Group HMO |
$684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$794.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.97
|
| Rate for Payer: PHCS Commercial |
$876.48
|
| Rate for Payer: United Healthcare All Payer |
$803.44
|
|
|
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: Ambetter Exchange |
$98.46
|
| Rate for Payer: Anthem Medicaid |
$62.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.15
|
| 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 |
$156.31
|
| Rate for Payer: Humana Medicaid |
$62.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.46
|
| 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 |
$128.00
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.46
|
|
|
SOFT TISSUE HEAD ULTRASOUND(T
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
402T0005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
SOFT TISSUE HEAD ULTRASOUND(T
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
402T0005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem Medicaid |
$270.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Humana KY Medicaid |
$270.99
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
SOFT-VU SO1 5F 80CM
|
Facility
|
OP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem Medicaid |
$176.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Humana KY Medicaid |
$176.13
|
| Rate for Payer: Kentucky WC Medicaid |
$177.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
SOFT-VU SO1 5F 80CM
|
Facility
|
IP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
SOLAR ELBOW AXLE PIN LRG
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SOLAR ELBOW AXLE PIN LRG
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SOLAR ELBOW AXLE PIN LRG RPL
|
Facility
|
OP
|
$9,313.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.91 |
| Max. Negotiated Rate |
$8,940.52 |
| Rate for Payer: Aetna Commercial |
$7,171.04
|
| Rate for Payer: Anthem Medicaid |
$3,202.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,264.17
|
| Rate for Payer: Cash Price |
$4,656.52
|
| Rate for Payer: Cigna Commercial |
$7,729.82
|
| Rate for Payer: First Health Commercial |
$8,847.39
|
| Rate for Payer: Humana Commercial |
$7,916.08
|
| Rate for Payer: Humana KY Medicaid |
$3,202.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,235.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,636.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,873.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,793.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,195.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,984.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,450.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,102.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,426.00
|
| Rate for Payer: PHCS Commercial |
$8,940.52
|
| Rate for Payer: United Healthcare All Payer |
$8,195.48
|
|
|
SOLAR ELBOW AXLE PIN LRG RPL
|
Facility
|
IP
|
$9,313.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.91 |
| Max. Negotiated Rate |
$8,940.52 |
| Rate for Payer: Aetna Commercial |
$7,171.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,264.17
|
| Rate for Payer: Cash Price |
$4,656.52
|
| Rate for Payer: Cigna Commercial |
$7,729.82
|
| Rate for Payer: First Health Commercial |
$8,847.39
|
| Rate for Payer: Humana Commercial |
$7,916.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,636.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,873.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,793.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,195.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,984.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,450.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,102.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,426.00
|
| Rate for Payer: PHCS Commercial |
$8,940.52
|
| Rate for Payer: United Healthcare All Payer |
$8,195.48
|
|
|
SOLAR HUMERAL HEAD 40*12
|
Facility
|
IP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 40*12
|
Facility
|
OP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 40*15
|
Facility
|
OP
|
$7,429.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.89 |
| Max. Negotiated Rate |
$7,132.45 |
| Rate for Payer: Aetna Commercial |
$5,720.82
|
| Rate for Payer: Anthem Medicaid |
$2,555.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,795.12
|
| Rate for Payer: Cash Price |
$3,714.82
|
| Rate for Payer: Cigna Commercial |
$6,166.60
|
| Rate for Payer: First Health Commercial |
$7,058.16
|
| Rate for Payer: Humana Commercial |
$6,315.19
|
| Rate for Payer: Humana KY Medicaid |
$2,555.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,581.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,092.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,483.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,606.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,538.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,572.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,943.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,463.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.45
|
| Rate for Payer: PHCS Commercial |
$7,132.45
|
| Rate for Payer: United Healthcare All Payer |
$6,538.08
|
|
|
SOLAR HUMERAL HEAD 40*15
|
Facility
|
IP
|
$7,429.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.89 |
| Max. Negotiated Rate |
$7,132.45 |
| Rate for Payer: Aetna Commercial |
$5,720.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,795.12
|
| Rate for Payer: Cash Price |
$3,714.82
|
| Rate for Payer: Cigna Commercial |
$6,166.60
|
| Rate for Payer: First Health Commercial |
$7,058.16
|
| Rate for Payer: Humana Commercial |
$6,315.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,092.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,483.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,538.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,572.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,943.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,463.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.45
|
| Rate for Payer: PHCS Commercial |
$7,132.45
|
| Rate for Payer: United Healthcare All Payer |
$6,538.08
|
|
|
SOLAR HUMERAL HEAD 40*18
|
Facility
|
IP
|
$7,128.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,138.66 |
| Max. Negotiated Rate |
$6,843.72 |
| Rate for Payer: Aetna Commercial |
$5,489.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.53
|
| Rate for Payer: Cash Price |
$3,564.44
|
| Rate for Payer: Cigna Commercial |
$5,916.97
|
| Rate for Payer: First Health Commercial |
$6,772.44
|
| Rate for Payer: Humana Commercial |
$6,059.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,261.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,273.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,703.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,202.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,918.93
|
| Rate for Payer: PHCS Commercial |
$6,843.72
|
| Rate for Payer: United Healthcare All Payer |
$6,273.41
|
|
|
SOLAR HUMERAL HEAD 40*18
|
Facility
|
OP
|
$7,128.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,138.66 |
| Max. Negotiated Rate |
$6,843.72 |
| Rate for Payer: Aetna Commercial |
$5,489.24
|
| Rate for Payer: Anthem Medicaid |
$2,451.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.53
|
| Rate for Payer: Cash Price |
$3,564.44
|
| Rate for Payer: Cigna Commercial |
$5,916.97
|
| Rate for Payer: First Health Commercial |
$6,772.44
|
| Rate for Payer: Humana Commercial |
$6,059.55
|
| Rate for Payer: Humana KY Medicaid |
$2,451.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,261.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,273.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,703.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,202.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,918.93
|
| Rate for Payer: PHCS Commercial |
$6,843.72
|
| Rate for Payer: United Healthcare All Payer |
$6,273.41
|
|
|
SOLAR HUMERAL HEAD 40*21
|
Facility
|
IP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 40*21
|
Facility
|
OP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 45*12
|
Facility
|
IP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 45*12
|
Facility
|
OP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
