|
SOLAR HUMERAL HEAD 45*15
|
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*15
|
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*18
|
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 45*18
|
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 45*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*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 45*24
|
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*24
|
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 50*15
|
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 50*15
|
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 50*18
|
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 50*18
|
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 50*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 50*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 50*24
|
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: Aetna Commercial |
$5,720.82
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem Medicaid |
$2,555.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,795.12
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cash Price |
$3,714.82
|
| Rate for Payer: Cigna Commercial |
$6,166.60
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$7,058.16
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana Commercial |
$6,315.19
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Humana KY Medicaid |
$2,555.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,581.06
|
| 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 HMO |
$6,092.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,483.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,606.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,538.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,572.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,943.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,463.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.45
|
| Rate for Payer: PHCS Commercial |
$7,132.45
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,538.08
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
SOLAR HUMERAL HEAD 50*24
|
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: Aetna Commercial |
$5,720.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,795.12
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cash Price |
$3,714.82
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: Cigna Commercial |
$6,166.60
|
| Rate for Payer: First Health Commercial |
$7,058.16
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,315.19
|
| 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 HMO |
$6,092.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| 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 Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,538.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,572.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,943.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| 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: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: PHCS Commercial |
$7,132.45
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
| Rate for Payer: United Healthcare All Payer |
$6,538.08
|
|
|
SOLAR HUMERAL HEAD 55*18
|
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 55*18
|
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 55*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 55*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 55*24
|
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 55*24
|
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 55*28
|
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 55*28
|
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 55*34
|
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
|
|
