|
SOL SYS 8 IN CALC 15.0MM
|
Facility
|
IP
|
$68,998.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,969.76 |
| Max. Negotiated Rate |
$66,238.26 |
| Rate for Payer: Aetna Commercial |
$53,128.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,818.59
|
| Rate for Payer: Cash Price |
$34,499.10
|
| Rate for Payer: Cigna Commercial |
$57,268.50
|
| Rate for Payer: First Health Commercial |
$65,548.28
|
| Rate for Payer: Humana Commercial |
$58,648.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,578.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,920.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,699.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,718.41
|
| Rate for Payer: Ohio Health Group HMO |
$51,748.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,969.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,389.44
|
| Rate for Payer: PHCS Commercial |
$66,238.26
|
| Rate for Payer: United Healthcare All Payer |
$60,718.41
|
|
|
SOL SYS 8 IN CALC 15.0MM
|
Facility
|
OP
|
$68,998.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,969.76 |
| Max. Negotiated Rate |
$66,238.26 |
| Rate for Payer: Aetna Commercial |
$53,128.61
|
| Rate for Payer: Anthem Medicaid |
$23,728.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,818.59
|
| Rate for Payer: Cash Price |
$34,499.10
|
| Rate for Payer: Cigna Commercial |
$57,268.50
|
| Rate for Payer: First Health Commercial |
$65,548.28
|
| Rate for Payer: Humana Commercial |
$58,648.46
|
| Rate for Payer: Humana KY Medicaid |
$23,728.48
|
| Rate for Payer: Kentucky WC Medicaid |
$23,969.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,578.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,920.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,699.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,204.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,718.41
|
| Rate for Payer: Ohio Health Group HMO |
$51,748.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,969.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,389.44
|
| Rate for Payer: PHCS Commercial |
$66,238.26
|
| Rate for Payer: United Healthcare All Payer |
$60,718.41
|
|
|
SOL SYS 8IN CALC 16.5MM
|
Facility
|
IP
|
$68,998.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,969.76 |
| Max. Negotiated Rate |
$66,238.26 |
| Rate for Payer: Aetna Commercial |
$53,128.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,818.59
|
| Rate for Payer: Cash Price |
$34,499.10
|
| Rate for Payer: Cigna Commercial |
$57,268.50
|
| Rate for Payer: First Health Commercial |
$65,548.28
|
| Rate for Payer: Humana Commercial |
$58,648.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,578.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,920.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,699.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,718.41
|
| Rate for Payer: Ohio Health Group HMO |
$51,748.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,969.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,389.44
|
| Rate for Payer: PHCS Commercial |
$66,238.26
|
| Rate for Payer: United Healthcare All Payer |
$60,718.41
|
|
|
SOL SYS 8IN CALC 16.5MM
|
Facility
|
OP
|
$68,998.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,969.76 |
| Max. Negotiated Rate |
$66,238.26 |
| Rate for Payer: Aetna Commercial |
$53,128.61
|
| Rate for Payer: Anthem Medicaid |
$23,728.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,818.59
|
| Rate for Payer: Cash Price |
$34,499.10
|
| Rate for Payer: Cigna Commercial |
$57,268.50
|
| Rate for Payer: First Health Commercial |
$65,548.28
|
| Rate for Payer: Humana Commercial |
$58,648.46
|
| Rate for Payer: Humana KY Medicaid |
$23,728.48
|
| Rate for Payer: Kentucky WC Medicaid |
$23,969.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,578.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,920.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,699.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,204.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,718.41
|
| Rate for Payer: Ohio Health Group HMO |
$51,748.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,969.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,389.44
|
| Rate for Payer: PHCS Commercial |
$66,238.26
|
| Rate for Payer: United Healthcare All Payer |
$60,718.41
|
|
|
SOL SYS 8IN CALC 18.0MM
|
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 18.0MM
|
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 19.5 MM
|
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 8 IN CALC 19.5 MM
|
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 STEM LG STAT L 13.5M
|
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 8 STEM LG STAT L 13.5M
|
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 STEM LG STAT L 16.5M
|
Facility
|
OP
|
$82,333.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,703.37 |
| Max. Negotiated Rate |
$79,040.26 |
| Rate for Payer: Aetna Commercial |
$63,396.87
|
| Rate for Payer: Anthem Medicaid |
$28,314.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,220.21
|
| Rate for Payer: Cash Price |
$41,166.80
|
| Rate for Payer: Cigna Commercial |
$68,336.89
|
| Rate for Payer: First Health Commercial |
$78,216.92
|
| Rate for Payer: Humana Commercial |
$69,983.56
|
| Rate for Payer: Humana KY Medicaid |
$28,314.53
|
| Rate for Payer: Kentucky WC Medicaid |
$28,602.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,513.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,762.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,700.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,882.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,453.57
|
| Rate for Payer: Ohio Health Group HMO |
$61,750.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,466.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,703.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,523.42
|
| Rate for Payer: PHCS Commercial |
$79,040.26
|
| Rate for Payer: United Healthcare All Payer |
$72,453.57
|
|
|
SOL SYS 8 STEM LG STAT L 16.5M
|
Facility
|
IP
|
$82,333.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,703.37 |
| Max. Negotiated Rate |
$79,040.26 |
| Rate for Payer: Aetna Commercial |
$63,396.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,220.21
|
| Rate for Payer: Cash Price |
$41,166.80
|
| Rate for Payer: Cigna Commercial |
$68,336.89
|
| Rate for Payer: First Health Commercial |
$78,216.92
|
| Rate for Payer: Humana Commercial |
$69,983.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,513.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,762.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,700.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,453.57
|
| Rate for Payer: Ohio Health Group HMO |
$61,750.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,466.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,703.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,523.42
|
| Rate for Payer: PHCS Commercial |
$79,040.26
|
| Rate for Payer: United Healthcare All Payer |
$72,453.57
|
|
|
SOL SYS 8 STEM LG STAT R 13.5M
|
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 8 STEM LG STAT R 13.5M
|
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 STEM LG STAT R 15.0M
|
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 STEM LG STAT R 15.0M
|
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 8 STEM LG STAT R 18.0M
|
Facility
|
IP
|
$82,333.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,703.37 |
| Max. Negotiated Rate |
$79,040.26 |
| Rate for Payer: Aetna Commercial |
$63,396.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,220.21
|
| Rate for Payer: Cash Price |
$41,166.80
|
| Rate for Payer: Cigna Commercial |
$68,336.89
|
| Rate for Payer: First Health Commercial |
$78,216.92
|
| Rate for Payer: Humana Commercial |
$69,983.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,513.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,762.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,700.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,453.57
|
| Rate for Payer: Ohio Health Group HMO |
$61,750.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,466.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,703.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,523.42
|
| Rate for Payer: PHCS Commercial |
$79,040.26
|
| Rate for Payer: United Healthcare All Payer |
$72,453.57
|
|
|
SOL SYS 8 STEM LG STAT R 18.0M
|
Facility
|
OP
|
$82,333.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,703.37 |
| Max. Negotiated Rate |
$79,040.26 |
| Rate for Payer: Aetna Commercial |
$63,396.87
|
| Rate for Payer: Anthem Medicaid |
$28,314.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,220.21
|
| Rate for Payer: Cash Price |
$41,166.80
|
| Rate for Payer: Cigna Commercial |
$68,336.89
|
| Rate for Payer: First Health Commercial |
$78,216.92
|
| Rate for Payer: Humana Commercial |
$69,983.56
|
| Rate for Payer: Humana KY Medicaid |
$28,314.53
|
| Rate for Payer: Kentucky WC Medicaid |
$28,602.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,513.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,762.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,700.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,882.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,453.57
|
| Rate for Payer: Ohio Health Group HMO |
$61,750.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,466.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,703.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,523.42
|
| Rate for Payer: PHCS Commercial |
$79,040.26
|
| Rate for Payer: United Healthcare All Payer |
$72,453.57
|
|
|
SOL SYS 8 ST LG STATURE SZ13.5
|
Facility
|
OP
|
$65,762.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,549.16 |
| Max. Negotiated Rate |
$63,132.29 |
| Rate for Payer: Aetna Commercial |
$50,637.36
|
| Rate for Payer: Anthem Medicaid |
$22,615.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,294.98
|
| Rate for Payer: Cash Price |
$32,881.40
|
| Rate for Payer: Cigna Commercial |
$54,583.12
|
| Rate for Payer: First Health Commercial |
$62,474.66
|
| Rate for Payer: Humana Commercial |
$55,898.38
|
| Rate for Payer: Humana KY Medicaid |
$22,615.83
|
| Rate for Payer: Kentucky WC Medicaid |
$22,846.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,925.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,532.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,728.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,069.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$57,871.26
|
| Rate for Payer: Ohio Health Group HMO |
$49,322.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,152.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,386.47
|
| Rate for Payer: PHCS Commercial |
$63,132.29
|
| Rate for Payer: United Healthcare All Payer |
$57,871.26
|
|
|
SOL SYS 8 ST LG STATURE SZ13.5
|
Facility
|
IP
|
$65,762.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,549.16 |
| Max. Negotiated Rate |
$63,132.29 |
| Rate for Payer: Aetna Commercial |
$50,637.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,294.98
|
| Rate for Payer: Cash Price |
$32,881.40
|
| Rate for Payer: Cigna Commercial |
$54,583.12
|
| Rate for Payer: First Health Commercial |
$62,474.66
|
| Rate for Payer: Humana Commercial |
$55,898.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,925.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,532.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,728.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$57,871.26
|
| Rate for Payer: Ohio Health Group HMO |
$49,322.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,152.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,386.47
|
| Rate for Payer: PHCS Commercial |
$63,132.29
|
| Rate for Payer: United Healthcare All Payer |
$57,871.26
|
|
|
SOL SYS 8 ST LG STATURE SZ16.5
|
Facility
|
IP
|
$75,648.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,834.29 |
| Max. Negotiated Rate |
$72,622.46 |
| Rate for Payer: Aetna Commercial |
$58,249.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,005.75
|
| Rate for Payer: Cash Price |
$37,824.20
|
| Rate for Payer: Cigna Commercial |
$62,788.17
|
| Rate for Payer: First Health Commercial |
$71,865.98
|
| Rate for Payer: Humana Commercial |
$64,301.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,031.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,828.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,694.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,570.59
|
| Rate for Payer: Ohio Health Group HMO |
$56,736.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,129.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,834.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,451.00
|
| Rate for Payer: PHCS Commercial |
$72,622.46
|
| Rate for Payer: United Healthcare All Payer |
$66,570.59
|
|
|
SOL SYS 8 ST LG STATURE SZ16.5
|
Facility
|
OP
|
$75,648.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,834.29 |
| Max. Negotiated Rate |
$72,622.46 |
| Rate for Payer: Aetna Commercial |
$58,249.27
|
| Rate for Payer: Anthem Medicaid |
$26,015.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,005.75
|
| Rate for Payer: Cash Price |
$37,824.20
|
| Rate for Payer: Cigna Commercial |
$62,788.17
|
| Rate for Payer: First Health Commercial |
$71,865.98
|
| Rate for Payer: Humana Commercial |
$64,301.14
|
| Rate for Payer: Humana KY Medicaid |
$26,015.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26,280.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,031.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,828.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,694.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,537.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,570.59
|
| Rate for Payer: Ohio Health Group HMO |
$56,736.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,129.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,834.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,451.00
|
| Rate for Payer: PHCS Commercial |
$72,622.46
|
| Rate for Payer: United Healthcare All Payer |
$66,570.59
|
|
|
SOL SYS 8 ST SMLL STATURSZ12.0
|
Facility
|
IP
|
$73,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,603.57 |
| Max. Negotiated Rate |
$70,918.66 |
| Rate for Payer: Aetna Commercial |
$56,882.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,621.41
|
| Rate for Payer: Cash Price |
$36,936.80
|
| Rate for Payer: Cigna Commercial |
$61,315.09
|
| Rate for Payer: First Health Commercial |
$70,179.92
|
| Rate for Payer: Humana Commercial |
$62,792.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,576.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,518.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,162.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,008.77
|
| Rate for Payer: Ohio Health Group HMO |
$55,405.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,603.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,900.82
|
| Rate for Payer: PHCS Commercial |
$70,918.66
|
| Rate for Payer: United Healthcare All Payer |
$65,008.77
|
|
|
SOL SYS 8 ST SMLL STATURSZ12.0
|
Facility
|
OP
|
$73,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,603.57 |
| Max. Negotiated Rate |
$70,918.66 |
| Rate for Payer: Aetna Commercial |
$56,882.67
|
| Rate for Payer: Anthem Medicaid |
$25,405.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,621.41
|
| Rate for Payer: Cash Price |
$36,936.80
|
| Rate for Payer: Cigna Commercial |
$61,315.09
|
| Rate for Payer: First Health Commercial |
$70,179.92
|
| Rate for Payer: Humana Commercial |
$62,792.56
|
| Rate for Payer: Humana KY Medicaid |
$25,405.13
|
| Rate for Payer: Kentucky WC Medicaid |
$25,663.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,576.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,518.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,162.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,914.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,008.77
|
| Rate for Payer: Ohio Health Group HMO |
$55,405.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,603.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,900.82
|
| Rate for Payer: PHCS Commercial |
$70,918.66
|
| Rate for Payer: United Healthcare All Payer |
$65,008.77
|
|
|
SOL SYS 8 ST SMLL STATURSZ13.5
|
Facility
|
OP
|
$75,648.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,834.29 |
| Max. Negotiated Rate |
$72,622.46 |
| Rate for Payer: Aetna Commercial |
$58,249.27
|
| Rate for Payer: Anthem Medicaid |
$26,015.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,005.75
|
| Rate for Payer: Cash Price |
$37,824.20
|
| Rate for Payer: Cigna Commercial |
$62,788.17
|
| Rate for Payer: First Health Commercial |
$71,865.98
|
| Rate for Payer: Humana Commercial |
$64,301.14
|
| Rate for Payer: Humana KY Medicaid |
$26,015.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26,280.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,031.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,828.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,694.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,537.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,570.59
|
| Rate for Payer: Ohio Health Group HMO |
$56,736.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,129.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,834.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,451.00
|
| Rate for Payer: PHCS Commercial |
$72,622.46
|
| Rate for Payer: United Healthcare All Payer |
$66,570.59
|
|
