|
SOLAR SHOULDER BIPOLAR 22MM +4
|
Facility
|
OP
|
$4,232.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.26 |
| Max. Negotiated Rate |
$4,063.49 |
| Rate for Payer: Aetna Commercial |
$3,259.26
|
| Rate for Payer: Anthem Medicaid |
$1,455.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,301.58
|
| Rate for Payer: Cash Price |
$2,116.40
|
| Rate for Payer: Cigna Commercial |
$3,513.22
|
| Rate for Payer: First Health Commercial |
$4,021.16
|
| Rate for Payer: Humana Commercial |
$3,597.88
|
| Rate for Payer: Humana KY Medicaid |
$1,455.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,470.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,470.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,123.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,484.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,724.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,174.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.17
|
| Rate for Payer: PHCS Commercial |
$4,063.49
|
| Rate for Payer: United Healthcare All Payer |
$3,724.86
|
|
|
SOLAR SHOULDER BIPOLAR 40MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
SOLAR SHOULDER BIPOLAR 40MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
SOLAR SHOULDER BIPOLAR 45MM
|
Facility
|
IP
|
$7,942.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.48 |
| Max. Negotiated Rate |
$7,624.44 |
| Rate for Payer: Aetna Commercial |
$6,115.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,194.85
|
| Rate for Payer: Cash Price |
$3,971.06
|
| Rate for Payer: Cigna Commercial |
$6,591.96
|
| Rate for Payer: First Health Commercial |
$7,545.01
|
| Rate for Payer: Humana Commercial |
$6,750.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,512.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,861.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,382.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,989.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,956.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.06
|
| Rate for Payer: PHCS Commercial |
$7,624.44
|
| Rate for Payer: United Healthcare All Payer |
$6,989.07
|
|
|
SOLAR SHOULDER BIPOLAR 45MM
|
Facility
|
OP
|
$7,942.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.48 |
| Max. Negotiated Rate |
$7,624.44 |
| Rate for Payer: Aetna Commercial |
$6,115.43
|
| Rate for Payer: Anthem Medicaid |
$2,731.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,194.85
|
| Rate for Payer: Cash Price |
$3,971.06
|
| Rate for Payer: Cigna Commercial |
$6,591.96
|
| Rate for Payer: First Health Commercial |
$7,545.01
|
| Rate for Payer: Humana Commercial |
$6,750.80
|
| Rate for Payer: Humana KY Medicaid |
$2,731.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,759.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,512.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,861.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,382.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,786.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,989.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,956.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.06
|
| Rate for Payer: PHCS Commercial |
$7,624.44
|
| Rate for Payer: United Healthcare All Payer |
$6,989.07
|
|
|
SOLAR SHOULDER BIPOLAR 50MM
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
SOLAR SHOULDER BIPOLAR 50MM
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
SOLAR SHOULDER BIPOLAR 55MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
SOLAR SHOULDER BIPOLAR 55MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
SOLENT PROXI
|
Facility
|
OP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
SOLENT PROXI
|
Facility
|
IP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
SOLIRIS 300MG/30ML VIAL
|
Facility
|
IP
|
$35,550.35
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
25002048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,621.55 |
| Max. Negotiated Rate |
$34,128.34 |
| Rate for Payer: Aetna Commercial |
$27,373.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.27
|
| Rate for Payer: Cash Price |
$17,775.18
|
| Rate for Payer: Cigna Commercial |
$29,506.79
|
| Rate for Payer: First Health Commercial |
$33,772.83
|
| Rate for Payer: Humana Commercial |
$30,217.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,151.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,284.31
|
| Rate for Payer: Ohio Health Group HMO |
$26,662.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.61
|
| Rate for Payer: PHCS Commercial |
$34,128.34
|
| Rate for Payer: United Healthcare All Payer |
$31,284.31
|
|
|
SOLIRIS 300MG/30ML VIAL
|
Facility
|
OP
|
$35,550.35
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
25002048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.68 |
| Max. Negotiated Rate |
$34,128.34 |
| Rate for Payer: Aetna Commercial |
$27,373.77
|
| Rate for Payer: Anthem Medicaid |
$12,225.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$225.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$315.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$304.67
|
| Rate for Payer: Cash Price |
$17,775.18
|
| Rate for Payer: Cash Price |
$17,775.18
|
| Rate for Payer: Cigna Commercial |
$29,506.79
|
| Rate for Payer: First Health Commercial |
$33,772.83
|
| Rate for Payer: Humana Commercial |
$30,217.80
|
| Rate for Payer: Humana KY Medicaid |
$12,225.77
|
| Rate for Payer: Humana Medicare Advantage |
$225.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12,350.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,151.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,471.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,284.31
|
| Rate for Payer: Ohio Health Group HMO |
$26,662.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.61
|
| Rate for Payer: PHCS Commercial |
$34,128.34
|
| Rate for Payer: United Healthcare All Payer |
$31,284.31
|
|
|
SOL SYS 10 12/14 BOW LG 13.5 R
|
Facility
|
IP
|
$79,615.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,350.03 |
| Max. Negotiated Rate |
$76,430.98 |
| Rate for Payer: Aetna Commercial |
$61,304.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,100.17
|
| Rate for Payer: Cash Price |
$39,807.80
|
| Rate for Payer: Cigna Commercial |
$66,080.95
|
| Rate for Payer: First Health Commercial |
$75,634.82
|
| Rate for Payer: Humana Commercial |
$67,673.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,284.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,756.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,884.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,061.73
|
| Rate for Payer: Ohio Health Group HMO |
$59,711.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,923.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,350.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,680.84
|
| Rate for Payer: PHCS Commercial |
$76,430.98
|
| Rate for Payer: United Healthcare All Payer |
$70,061.73
|
|
|
SOL SYS 10 12/14 BOW LG 13.5 R
|
Facility
|
OP
|
$79,615.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,350.03 |
| Max. Negotiated Rate |
$76,430.98 |
| Rate for Payer: Aetna Commercial |
$61,304.01
|
| Rate for Payer: Anthem Medicaid |
$27,379.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,100.17
|
| Rate for Payer: Cash Price |
$39,807.80
|
| Rate for Payer: Cigna Commercial |
$66,080.95
|
| Rate for Payer: First Health Commercial |
$75,634.82
|
| Rate for Payer: Humana Commercial |
$67,673.26
|
| Rate for Payer: Humana KY Medicaid |
$27,379.80
|
| Rate for Payer: Kentucky WC Medicaid |
$27,658.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,284.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,756.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,884.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,929.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,061.73
|
| Rate for Payer: Ohio Health Group HMO |
$59,711.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,923.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,350.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,680.84
|
| Rate for Payer: PHCS Commercial |
$76,430.98
|
| Rate for Payer: United Healthcare All Payer |
$70,061.73
|
|
|
SOL SYS 10 BOW IMP 10/16.5 LT
|
Facility
|
IP
|
$74,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,689.68 |
| Max. Negotiated Rate |
$71,554.56 |
| Rate for Payer: Aetna Commercial |
$57,392.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,138.08
|
| Rate for Payer: Cash Price |
$37,268.00
|
| Rate for Payer: Cigna Commercial |
$61,864.88
|
| Rate for Payer: First Health Commercial |
$70,809.20
|
| Rate for Payer: Humana Commercial |
$63,355.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,119.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,007.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,360.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,591.68
|
| Rate for Payer: Ohio Health Group HMO |
$55,902.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,689.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,106.16
|
| Rate for Payer: PHCS Commercial |
$71,554.56
|
| Rate for Payer: United Healthcare All Payer |
$65,591.68
|
|
|
SOL SYS 10 BOW IMP 10/16.5 LT
|
Facility
|
OP
|
$74,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,689.68 |
| Max. Negotiated Rate |
$71,554.56 |
| Rate for Payer: Aetna Commercial |
$57,392.72
|
| Rate for Payer: Anthem Medicaid |
$25,632.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,138.08
|
| Rate for Payer: Cash Price |
$37,268.00
|
| Rate for Payer: Cigna Commercial |
$61,864.88
|
| Rate for Payer: First Health Commercial |
$70,809.20
|
| Rate for Payer: Humana Commercial |
$63,355.60
|
| Rate for Payer: Humana KY Medicaid |
$25,632.93
|
| Rate for Payer: Kentucky WC Medicaid |
$25,893.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,119.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,007.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,360.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,147.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,591.68
|
| Rate for Payer: Ohio Health Group HMO |
$55,902.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,689.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,106.16
|
| Rate for Payer: PHCS Commercial |
$71,554.56
|
| Rate for Payer: United Healthcare All Payer |
$65,591.68
|
|
|
SOL SYS 10 LG STATURE L 13.5MM
|
Facility
|
OP
|
$73,225.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,519.33 |
| Max. Negotiated Rate |
$70,296.58 |
| Rate for Payer: Aetna Commercial |
$56,383.71
|
| Rate for Payer: Anthem Medicaid |
$25,182.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,115.97
|
| Rate for Payer: Cash Price |
$36,612.80
|
| Rate for Payer: Cigna Commercial |
$60,777.25
|
| Rate for Payer: First Health Commercial |
$69,564.32
|
| Rate for Payer: Humana Commercial |
$62,241.76
|
| Rate for Payer: Humana KY Medicaid |
$25,182.28
|
| Rate for Payer: Kentucky WC Medicaid |
$25,438.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,044.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,040.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,967.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,438.53
|
| Rate for Payer: Ohio Health Group HMO |
$54,919.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,645.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,519.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,699.94
|
| Rate for Payer: PHCS Commercial |
$70,296.58
|
| Rate for Payer: United Healthcare All Payer |
$64,438.53
|
|
|
SOL SYS 10 LG STATURE L 13.5MM
|
Facility
|
IP
|
$73,225.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,519.33 |
| Max. Negotiated Rate |
$70,296.58 |
| Rate for Payer: Aetna Commercial |
$56,383.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,115.97
|
| Rate for Payer: Cash Price |
$36,612.80
|
| Rate for Payer: Cigna Commercial |
$60,777.25
|
| Rate for Payer: First Health Commercial |
$69,564.32
|
| Rate for Payer: Humana Commercial |
$62,241.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,044.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,040.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,967.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,438.53
|
| Rate for Payer: Ohio Health Group HMO |
$54,919.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,645.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,519.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,699.94
|
| Rate for Payer: PHCS Commercial |
$70,296.58
|
| Rate for Payer: United Healthcare All Payer |
$64,438.53
|
|
|
SOL SYS 8 FEM/STEM 12/14 LG LE
|
Facility
|
IP
|
$76,654.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,965.10 |
| Max. Negotiated Rate |
$73,588.42 |
| Rate for Payer: Aetna Commercial |
$59,024.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,790.59
|
| Rate for Payer: Cash Price |
$38,327.30
|
| Rate for Payer: Cigna Commercial |
$63,623.32
|
| Rate for Payer: First Health Commercial |
$72,821.87
|
| Rate for Payer: Humana Commercial |
$65,156.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,856.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,996.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,456.05
|
| Rate for Payer: Ohio Health Group HMO |
$57,490.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,330.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,965.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,762.93
|
| Rate for Payer: PHCS Commercial |
$73,588.42
|
| Rate for Payer: United Healthcare All Payer |
$67,456.05
|
|
|
SOL SYS 8 FEM/STEM 12/14 LG LE
|
Facility
|
OP
|
$76,654.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,965.10 |
| Max. Negotiated Rate |
$73,588.42 |
| Rate for Payer: Aetna Commercial |
$59,024.04
|
| Rate for Payer: Anthem Medicaid |
$26,361.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,790.59
|
| Rate for Payer: Cash Price |
$38,327.30
|
| Rate for Payer: Cigna Commercial |
$63,623.32
|
| Rate for Payer: First Health Commercial |
$72,821.87
|
| Rate for Payer: Humana Commercial |
$65,156.41
|
| Rate for Payer: Humana KY Medicaid |
$26,361.52
|
| Rate for Payer: Kentucky WC Medicaid |
$26,629.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,856.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,996.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,890.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,456.05
|
| Rate for Payer: Ohio Health Group HMO |
$57,490.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,330.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,965.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,762.93
|
| Rate for Payer: PHCS Commercial |
$73,588.42
|
| Rate for Payer: United Healthcare All Payer |
$67,456.05
|
|
|
SOL SYS 8IN CALC 12.0MM
|
Facility
|
OP
|
$39,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,108.02 |
| Max. Negotiated Rate |
$37,720.80 |
| Rate for Payer: Aetna Commercial |
$30,255.22
|
| Rate for Payer: Anthem Medicaid |
$13,512.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,648.15
|
| Rate for Payer: Cash Price |
$19,646.25
|
| Rate for Payer: Cigna Commercial |
$32,612.78
|
| Rate for Payer: First Health Commercial |
$37,327.88
|
| Rate for Payer: Humana Commercial |
$33,398.62
|
| Rate for Payer: Humana KY Medicaid |
$13,512.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,650.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,219.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,997.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,787.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,783.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,577.40
|
| Rate for Payer: Ohio Health Group HMO |
$29,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,858.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,180.68
|
| Rate for Payer: PHCS Commercial |
$37,720.80
|
| Rate for Payer: United Healthcare All Payer |
$34,577.40
|
|
|
SOL SYS 8IN CALC 12.0MM
|
Facility
|
IP
|
$39,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,108.02 |
| Max. Negotiated Rate |
$37,720.80 |
| Rate for Payer: Aetna Commercial |
$30,255.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,648.15
|
| Rate for Payer: Cash Price |
$19,646.25
|
| Rate for Payer: Cigna Commercial |
$32,612.78
|
| Rate for Payer: First Health Commercial |
$37,327.88
|
| Rate for Payer: Humana Commercial |
$33,398.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,219.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,997.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,787.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,577.40
|
| Rate for Payer: Ohio Health Group HMO |
$29,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,858.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,180.68
|
| Rate for Payer: PHCS Commercial |
$37,720.80
|
| Rate for Payer: United Healthcare All Payer |
$34,577.40
|
|
|
SOL SYS 8 IN CALC 13.5MM
|
Facility
|
IP
|
$39,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,108.02 |
| Max. Negotiated Rate |
$37,720.80 |
| Rate for Payer: Aetna Commercial |
$30,255.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,648.15
|
| Rate for Payer: Cash Price |
$19,646.25
|
| Rate for Payer: Cigna Commercial |
$32,612.78
|
| Rate for Payer: First Health Commercial |
$37,327.88
|
| Rate for Payer: Humana Commercial |
$33,398.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,219.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,997.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,787.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,577.40
|
| Rate for Payer: Ohio Health Group HMO |
$29,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,858.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,180.68
|
| Rate for Payer: PHCS Commercial |
$37,720.80
|
| Rate for Payer: United Healthcare All Payer |
$34,577.40
|
|
|
SOL SYS 8 IN CALC 13.5MM
|
Facility
|
OP
|
$39,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,108.02 |
| Max. Negotiated Rate |
$37,720.80 |
| Rate for Payer: Aetna Commercial |
$30,255.22
|
| Rate for Payer: Anthem Medicaid |
$13,512.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,648.15
|
| Rate for Payer: Cash Price |
$19,646.25
|
| Rate for Payer: Cigna Commercial |
$32,612.78
|
| Rate for Payer: First Health Commercial |
$37,327.88
|
| Rate for Payer: Humana Commercial |
$33,398.62
|
| Rate for Payer: Humana KY Medicaid |
$13,512.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,650.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,219.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,997.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,787.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,783.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,577.40
|
| Rate for Payer: Ohio Health Group HMO |
$29,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,858.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,180.68
|
| Rate for Payer: PHCS Commercial |
$37,720.80
|
| Rate for Payer: United Healthcare All Payer |
$34,577.40
|
|
