|
SOLAR HUMERAL STEM SHLDR 9MM
|
Facility
|
OP
|
$13,400.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,020.06 |
| Max. Negotiated Rate |
$12,864.18 |
| Rate for Payer: Aetna Commercial |
$10,318.15
|
| Rate for Payer: Anthem Medicaid |
$4,608.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,452.15
|
| Rate for Payer: Cash Price |
$6,700.10
|
| Rate for Payer: Cigna Commercial |
$11,122.16
|
| Rate for Payer: First Health Commercial |
$12,730.18
|
| Rate for Payer: Humana Commercial |
$11,390.16
|
| Rate for Payer: Humana KY Medicaid |
$4,608.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,655.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,988.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,889.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,020.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,700.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,792.17
|
| Rate for Payer: Ohio Health Group HMO |
$10,050.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,720.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,658.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,246.13
|
| Rate for Payer: PHCS Commercial |
$12,864.18
|
| Rate for Payer: United Healthcare All Payer |
$11,792.17
|
|
|
SOLAR HUMERAL STEM SHLDR 9MM
|
Facility
|
IP
|
$13,400.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,020.06 |
| Max. Negotiated Rate |
$12,864.18 |
| Rate for Payer: Aetna Commercial |
$10,318.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,452.15
|
| Rate for Payer: Cash Price |
$6,700.10
|
| Rate for Payer: Cigna Commercial |
$11,122.16
|
| Rate for Payer: First Health Commercial |
$12,730.18
|
| Rate for Payer: Humana Commercial |
$11,390.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,988.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,889.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,020.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,792.17
|
| Rate for Payer: Ohio Health Group HMO |
$10,050.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,720.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,658.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,246.13
|
| Rate for Payer: PHCS Commercial |
$12,864.18
|
| Rate for Payer: United Healthcare All Payer |
$11,792.17
|
|
|
SOLAR HUMRL STEM SHOULD 11*200
|
Facility
|
IP
|
$16,867.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.26 |
| Max. Negotiated Rate |
$16,192.82 |
| Rate for Payer: Aetna Commercial |
$12,987.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,156.67
|
| Rate for Payer: Cash Price |
$8,433.76
|
| Rate for Payer: Cigna Commercial |
$14,000.04
|
| Rate for Payer: First Health Commercial |
$16,024.14
|
| Rate for Payer: Humana Commercial |
$14,337.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,448.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,060.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,843.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,650.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,494.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,674.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,638.59
|
| Rate for Payer: PHCS Commercial |
$16,192.82
|
| Rate for Payer: United Healthcare All Payer |
$14,843.42
|
|
|
SOLAR HUMRL STEM SHOULD 11*200
|
Facility
|
OP
|
$16,867.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.26 |
| Max. Negotiated Rate |
$16,192.82 |
| Rate for Payer: Aetna Commercial |
$12,987.99
|
| Rate for Payer: Anthem Medicaid |
$5,800.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,156.67
|
| Rate for Payer: Cash Price |
$8,433.76
|
| Rate for Payer: Cigna Commercial |
$14,000.04
|
| Rate for Payer: First Health Commercial |
$16,024.14
|
| Rate for Payer: Humana Commercial |
$14,337.39
|
| Rate for Payer: Humana KY Medicaid |
$5,800.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5,859.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,448.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,060.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,917.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,843.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,650.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,494.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,674.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,638.59
|
| Rate for Payer: PHCS Commercial |
$16,192.82
|
| Rate for Payer: United Healthcare All Payer |
$14,843.42
|
|
|
SOLAR HUMRL STEM SHOULD 13*200
|
Facility
|
OP
|
$15,571.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,671.31 |
| Max. Negotiated Rate |
$14,948.20 |
| Rate for Payer: Aetna Commercial |
$11,989.70
|
| Rate for Payer: Anthem Medicaid |
$5,354.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,145.41
|
| Rate for Payer: Cash Price |
$7,785.52
|
| Rate for Payer: Cigna Commercial |
$12,923.96
|
| Rate for Payer: First Health Commercial |
$14,792.49
|
| Rate for Payer: Humana Commercial |
$13,235.38
|
| Rate for Payer: Humana KY Medicaid |
$5,354.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,768.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,491.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,671.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,462.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,702.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,678.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,456.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,546.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,744.02
|
| Rate for Payer: PHCS Commercial |
$14,948.20
|
| Rate for Payer: United Healthcare All Payer |
$13,702.52
|
|
|
SOLAR HUMRL STEM SHOULD 13*200
|
Facility
|
IP
|
$15,571.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,671.31 |
| Max. Negotiated Rate |
$14,948.20 |
| Rate for Payer: Aetna Commercial |
$11,989.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,145.41
|
| Rate for Payer: Cash Price |
$7,785.52
|
| Rate for Payer: Cigna Commercial |
$12,923.96
|
| Rate for Payer: First Health Commercial |
$14,792.49
|
| Rate for Payer: Humana Commercial |
$13,235.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,768.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,491.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,671.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,702.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,678.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,456.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,546.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,744.02
|
| Rate for Payer: PHCS Commercial |
$14,948.20
|
| Rate for Payer: United Healthcare All Payer |
$13,702.52
|
|
|
SOLAR KEELED GLENOID SZ #5
|
Facility
|
IP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SOLAR KEELED GLENOID SZ #5
|
Facility
|
OP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem Medicaid |
$2,630.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Humana KY Medicaid |
$2,630.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,657.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,683.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SOLAR OFFSET HUM HEAD 40*15
|
Facility
|
IP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 40*15
|
Facility
|
OP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem Medicaid |
$2,776.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Humana KY Medicaid |
$2,776.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,832.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 40*18
|
Facility
|
IP
|
$7,870.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.17 |
| Max. Negotiated Rate |
$7,555.74 |
| Rate for Payer: Aetna Commercial |
$6,060.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.04
|
| Rate for Payer: Cash Price |
$3,935.28
|
| Rate for Payer: Cigna Commercial |
$6,532.56
|
| Rate for Payer: First Health Commercial |
$7,477.03
|
| Rate for Payer: Humana Commercial |
$6,689.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,808.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,926.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,902.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,296.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,847.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,430.69
|
| Rate for Payer: PHCS Commercial |
$7,555.74
|
| Rate for Payer: United Healthcare All Payer |
$6,926.09
|
|
|
SOLAR OFFSET HUM HEAD 40*18
|
Facility
|
OP
|
$7,870.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.17 |
| Max. Negotiated Rate |
$7,555.74 |
| Rate for Payer: Aetna Commercial |
$6,060.33
|
| Rate for Payer: Anthem Medicaid |
$2,706.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.04
|
| Rate for Payer: Cash Price |
$3,935.28
|
| Rate for Payer: Cigna Commercial |
$6,532.56
|
| Rate for Payer: First Health Commercial |
$7,477.03
|
| Rate for Payer: Humana Commercial |
$6,689.98
|
| Rate for Payer: Humana KY Medicaid |
$2,706.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,808.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,760.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,926.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,902.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,296.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,847.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,430.69
|
| Rate for Payer: PHCS Commercial |
$7,555.74
|
| Rate for Payer: United Healthcare All Payer |
$6,926.09
|
|
|
SOLAR OFFSET HUM HEAD 45*15
|
Facility
|
IP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 45*15
|
Facility
|
OP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem Medicaid |
$2,776.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Humana KY Medicaid |
$2,776.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,832.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 45*18
|
Facility
|
IP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 45*18
|
Facility
|
OP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem Medicaid |
$2,776.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Humana KY Medicaid |
$2,776.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,832.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOLAR OFFSET HUM HEAD 45*21
|
Facility
|
IP
|
$7,683.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.10 |
| Max. Negotiated Rate |
$7,376.33 |
| Rate for Payer: Aetna Commercial |
$5,916.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.27
|
| Rate for Payer: Cash Price |
$3,841.84
|
| Rate for Payer: Cigna Commercial |
$6,377.45
|
| Rate for Payer: First Health Commercial |
$7,299.50
|
| Rate for Payer: Humana Commercial |
$6,531.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,146.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,684.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,301.74
|
| Rate for Payer: PHCS Commercial |
$7,376.33
|
| Rate for Payer: United Healthcare All Payer |
$6,761.64
|
|
|
SOLAR OFFSET HUM HEAD 45*21
|
Facility
|
OP
|
$7,683.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.10 |
| Max. Negotiated Rate |
$7,376.33 |
| Rate for Payer: Aetna Commercial |
$5,916.43
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.27
|
| Rate for Payer: Cash Price |
$3,841.84
|
| Rate for Payer: Cigna Commercial |
$6,377.45
|
| Rate for Payer: First Health Commercial |
$7,299.50
|
| Rate for Payer: Humana Commercial |
$6,531.13
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,146.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,684.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,301.74
|
| Rate for Payer: PHCS Commercial |
$7,376.33
|
| Rate for Payer: United Healthcare All Payer |
$6,761.64
|
|
|
SOLAR OFFSET HUM HEAD 50*21
|
Facility
|
IP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
SOLAR OFFSET HUM HEAD 50*21
|
Facility
|
OP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem Medicaid |
$2,522.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Humana KY Medicaid |
$2,522.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,548.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,573.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +0
|
Facility
|
IP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +0
|
Facility
|
OP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem Medicaid |
$1,600.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Humana KY Medicaid |
$1,600.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,632.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +2
|
Facility
|
IP
|
$4,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.20 |
| Max. Negotiated Rate |
$4,189.44 |
| Rate for Payer: Aetna Commercial |
$3,360.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.92
|
| Rate for Payer: Cash Price |
$2,182.00
|
| Rate for Payer: Cigna Commercial |
$3,622.12
|
| Rate for Payer: First Health Commercial |
$4,145.80
|
| Rate for Payer: Humana Commercial |
$3,709.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,578.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,220.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,840.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,796.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.16
|
| Rate for Payer: PHCS Commercial |
$4,189.44
|
| Rate for Payer: United Healthcare All Payer |
$3,840.32
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +2
|
Facility
|
OP
|
$4,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.20 |
| Max. Negotiated Rate |
$4,189.44 |
| Rate for Payer: Aetna Commercial |
$3,360.28
|
| Rate for Payer: Anthem Medicaid |
$1,500.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.92
|
| Rate for Payer: Cash Price |
$2,182.00
|
| Rate for Payer: Cigna Commercial |
$3,622.12
|
| Rate for Payer: First Health Commercial |
$4,145.80
|
| Rate for Payer: Humana Commercial |
$3,709.40
|
| Rate for Payer: Humana KY Medicaid |
$1,500.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,578.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,220.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,530.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,840.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,796.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.16
|
| Rate for Payer: PHCS Commercial |
$4,189.44
|
| Rate for Payer: United Healthcare All Payer |
$3,840.32
|
|
|
SOLAR SHOULDER BIPOLAR 22MM +4
|
Facility
|
OP
|
$4,178.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.40 |
| Max. Negotiated Rate |
$4,010.88 |
| Rate for Payer: Aetna Commercial |
$3,217.06
|
| Rate for Payer: Anthem Medicaid |
$1,436.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,258.84
|
| Rate for Payer: Cash Price |
$2,089.00
|
| Rate for Payer: Cigna Commercial |
$3,467.74
|
| Rate for Payer: First Health Commercial |
$3,969.10
|
| Rate for Payer: Humana Commercial |
$3,551.30
|
| Rate for Payer: Humana KY Medicaid |
$1,436.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,451.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,425.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,083.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,676.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,133.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,634.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.82
|
| Rate for Payer: PHCS Commercial |
$4,010.88
|
| Rate for Payer: United Healthcare All Payer |
$3,676.64
|
|
