|
SOLAR SHOULDER BIPOLAR 22MM +4
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SOLAR SHOULDER BIPOLAR 40MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
SOLAR SHOULDER BIPOLAR 40MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
SOLAR SHOULDER BIPOLAR 45MM
|
Facility
|
OP
|
$8,142.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.64 |
| Max. Negotiated Rate |
$7,816.44 |
| Rate for Payer: Aetna Commercial |
$6,269.43
|
| Rate for Payer: Anthem Medicaid |
$2,800.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,350.85
|
| Rate for Payer: Cash Price |
$4,071.06
|
| Rate for Payer: Cigna Commercial |
$6,757.96
|
| Rate for Payer: First Health Commercial |
$7,735.01
|
| Rate for Payer: Humana Commercial |
$6,920.80
|
| Rate for Payer: Humana KY Medicaid |
$2,800.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,828.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,676.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,008.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,442.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,856.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,165.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,106.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,513.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,083.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,618.06
|
| Rate for Payer: PHCS Commercial |
$7,816.44
|
| Rate for Payer: United Healthcare All Payer |
$7,165.07
|
|
|
SOLAR SHOULDER BIPOLAR 45MM
|
Facility
|
IP
|
$8,142.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.64 |
| Max. Negotiated Rate |
$7,816.44 |
| Rate for Payer: Aetna Commercial |
$6,269.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,350.85
|
| Rate for Payer: Cash Price |
$4,071.06
|
| Rate for Payer: Cigna Commercial |
$6,757.96
|
| Rate for Payer: First Health Commercial |
$7,735.01
|
| Rate for Payer: Humana Commercial |
$6,920.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,676.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,008.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,442.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,165.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,106.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,513.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,083.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,618.06
|
| Rate for Payer: PHCS Commercial |
$7,816.44
|
| Rate for Payer: United Healthcare All Payer |
$7,165.07
|
|
|
SOLAR SHOULDER BIPOLAR 50MM
|
Facility
|
IP
|
$7,599.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.70 |
| Max. Negotiated Rate |
$7,295.04 |
| Rate for Payer: Aetna Commercial |
$5,851.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.22
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: Cigna Commercial |
$6,307.17
|
| Rate for Payer: First Health Commercial |
$7,219.05
|
| Rate for Payer: Humana Commercial |
$6,459.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,611.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,243.31
|
| Rate for Payer: PHCS Commercial |
$7,295.04
|
| Rate for Payer: United Healthcare All Payer |
$6,687.12
|
|
|
SOLAR SHOULDER BIPOLAR 50MM
|
Facility
|
OP
|
$7,599.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.70 |
| Max. Negotiated Rate |
$7,295.04 |
| Rate for Payer: Aetna Commercial |
$5,851.23
|
| Rate for Payer: Anthem Medicaid |
$2,613.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.22
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: Cigna Commercial |
$6,307.17
|
| Rate for Payer: First Health Commercial |
$7,219.05
|
| Rate for Payer: Humana Commercial |
$6,459.15
|
| Rate for Payer: Humana KY Medicaid |
$2,613.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,611.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,243.31
|
| Rate for Payer: PHCS Commercial |
$7,295.04
|
| Rate for Payer: United Healthcare All Payer |
$6,687.12
|
|
|
SOLAR SHOULDER BIPOLAR 55MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
SOLAR SHOULDER BIPOLAR 55MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
SOLENT PROXI
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
SOLENT PROXI
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
SOLIRIS (2mg)300mg/30ml
|
Facility
|
IP
|
$35,550.35
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
25002048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,665.10 |
| 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 |
$28,440.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,928.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,529.74
|
| Rate for Payer: PHCS Commercial |
$34,128.34
|
| Rate for Payer: United Healthcare All Payer |
$31,284.31
|
|
|
SOLIRIS (2mg)300mg/30ml
|
Facility
|
OP
|
$35,550.35
|
|
|
Service Code
|
HCPCS J1299
|
| Hospital Charge Code |
25002048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.77 |
| 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 |
$44.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.44
|
| 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 |
$44.77
|
| 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 |
$53.72
|
| 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 |
$28,440.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,928.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,529.74
|
| 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
|
OP
|
$82,399.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,719.94 |
| Max. Negotiated Rate |
$79,103.81 |
| Rate for Payer: Aetna Commercial |
$63,447.85
|
| Rate for Payer: Anthem Medicaid |
$28,337.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,271.84
|
| Rate for Payer: Cash Price |
$41,199.90
|
| Rate for Payer: Cigna Commercial |
$68,391.83
|
| Rate for Payer: First Health Commercial |
$78,279.81
|
| Rate for Payer: Humana Commercial |
$70,039.83
|
| Rate for Payer: Humana KY Medicaid |
$28,337.29
|
| Rate for Payer: Kentucky WC Medicaid |
$28,625.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,567.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,811.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,719.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,905.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,511.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,919.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,687.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,855.86
|
| Rate for Payer: PHCS Commercial |
$79,103.81
|
| Rate for Payer: United Healthcare All Payer |
$72,511.82
|
|
|
SOL SYS 10 12/14 BOW LG 13.5 R
|
Facility
|
IP
|
$82,399.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,719.94 |
| Max. Negotiated Rate |
$79,103.81 |
| Rate for Payer: Aetna Commercial |
$63,447.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,271.84
|
| Rate for Payer: Cash Price |
$41,199.90
|
| Rate for Payer: Cigna Commercial |
$68,391.83
|
| Rate for Payer: First Health Commercial |
$78,279.81
|
| Rate for Payer: Humana Commercial |
$70,039.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,567.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,811.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,719.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,511.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,919.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,687.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,855.86
|
| Rate for Payer: PHCS Commercial |
$79,103.81
|
| Rate for Payer: United Healthcare All Payer |
$72,511.82
|
|
|
SOL SYS 10 BOW IMP 10/16.5 LT
|
Facility
|
IP
|
$77,038.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,111.40 |
| Max. Negotiated Rate |
$73,956.48 |
| Rate for Payer: Aetna Commercial |
$59,319.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,089.64
|
| Rate for Payer: Cash Price |
$38,519.00
|
| Rate for Payer: Cigna Commercial |
$63,941.54
|
| Rate for Payer: First Health Commercial |
$73,186.10
|
| Rate for Payer: Humana Commercial |
$65,482.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,171.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,854.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,111.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,793.44
|
| Rate for Payer: Ohio Health Group HMO |
$57,778.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,023.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,156.22
|
| Rate for Payer: PHCS Commercial |
$73,956.48
|
| Rate for Payer: United Healthcare All Payer |
$67,793.44
|
|
|
SOL SYS 10 BOW IMP 10/16.5 LT
|
Facility
|
OP
|
$77,038.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,111.40 |
| Max. Negotiated Rate |
$73,956.48 |
| Rate for Payer: Aetna Commercial |
$59,319.26
|
| Rate for Payer: Anthem Medicaid |
$26,493.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,089.64
|
| Rate for Payer: Cash Price |
$38,519.00
|
| Rate for Payer: Cigna Commercial |
$63,941.54
|
| Rate for Payer: First Health Commercial |
$73,186.10
|
| Rate for Payer: Humana Commercial |
$65,482.30
|
| Rate for Payer: Humana KY Medicaid |
$26,493.37
|
| Rate for Payer: Kentucky WC Medicaid |
$26,763.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,171.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,854.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,111.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,024.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,793.44
|
| Rate for Payer: Ohio Health Group HMO |
$57,778.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,023.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,156.22
|
| Rate for Payer: PHCS Commercial |
$73,956.48
|
| Rate for Payer: United Healthcare All Payer |
$67,793.44
|
|
|
SOL SYS 10 LG STATURE L 13.5MM
|
Facility
|
IP
|
$75,654.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,696.44 |
| Max. Negotiated Rate |
$72,628.61 |
| Rate for Payer: Aetna Commercial |
$58,254.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,010.74
|
| Rate for Payer: Cash Price |
$37,827.40
|
| Rate for Payer: Cigna Commercial |
$62,793.48
|
| Rate for Payer: First Health Commercial |
$71,872.06
|
| Rate for Payer: Humana Commercial |
$64,306.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,036.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,833.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,696.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,576.22
|
| Rate for Payer: Ohio Health Group HMO |
$56,741.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,523.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,819.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,201.81
|
| Rate for Payer: PHCS Commercial |
$72,628.61
|
| Rate for Payer: United Healthcare All Payer |
$66,576.22
|
|
|
SOL SYS 10 LG STATURE L 13.5MM
|
Facility
|
OP
|
$75,654.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,696.44 |
| Max. Negotiated Rate |
$72,628.61 |
| Rate for Payer: Aetna Commercial |
$58,254.20
|
| Rate for Payer: Anthem Medicaid |
$26,017.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,010.74
|
| Rate for Payer: Cash Price |
$37,827.40
|
| Rate for Payer: Cigna Commercial |
$62,793.48
|
| Rate for Payer: First Health Commercial |
$71,872.06
|
| Rate for Payer: Humana Commercial |
$64,306.58
|
| Rate for Payer: Humana KY Medicaid |
$26,017.69
|
| Rate for Payer: Kentucky WC Medicaid |
$26,282.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,036.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,833.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,696.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,539.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,576.22
|
| Rate for Payer: Ohio Health Group HMO |
$56,741.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,523.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,819.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,201.81
|
| Rate for Payer: PHCS Commercial |
$72,628.61
|
| Rate for Payer: United Healthcare All Payer |
$66,576.22
|
|
|
SOL SYS 8 FEM/STEM 12/14 LG LE
|
Facility
|
IP
|
$79,274.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,782.29 |
| Max. Negotiated Rate |
$76,103.33 |
| Rate for Payer: Aetna Commercial |
$61,041.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,833.95
|
| Rate for Payer: Cash Price |
$39,637.15
|
| Rate for Payer: Cigna Commercial |
$65,797.67
|
| Rate for Payer: First Health Commercial |
$75,310.59
|
| Rate for Payer: Humana Commercial |
$67,383.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,004.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,504.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,782.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,761.38
|
| Rate for Payer: Ohio Health Group HMO |
$59,455.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,419.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,968.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,699.27
|
| Rate for Payer: PHCS Commercial |
$76,103.33
|
| Rate for Payer: United Healthcare All Payer |
$69,761.38
|
|
|
SOL SYS 8 FEM/STEM 12/14 LG LE
|
Facility
|
OP
|
$79,274.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,782.29 |
| Max. Negotiated Rate |
$76,103.33 |
| Rate for Payer: Aetna Commercial |
$61,041.21
|
| Rate for Payer: Anthem Medicaid |
$27,262.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,833.95
|
| Rate for Payer: Cash Price |
$39,637.15
|
| Rate for Payer: Cigna Commercial |
$65,797.67
|
| Rate for Payer: First Health Commercial |
$75,310.59
|
| Rate for Payer: Humana Commercial |
$67,383.15
|
| Rate for Payer: Humana KY Medicaid |
$27,262.43
|
| Rate for Payer: Kentucky WC Medicaid |
$27,539.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,004.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,504.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,782.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,809.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,761.38
|
| Rate for Payer: Ohio Health Group HMO |
$59,455.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,419.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,968.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,699.27
|
| Rate for Payer: PHCS Commercial |
$76,103.33
|
| Rate for Payer: United Healthcare All Payer |
$69,761.38
|
|
|
SOL SYS 8IN CALC 12.0MM
|
Facility
|
OP
|
$40,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,131.25 |
| Max. Negotiated Rate |
$38,820.00 |
| Rate for Payer: Aetna Commercial |
$31,136.88
|
| Rate for Payer: Anthem Medicaid |
$13,906.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,541.25
|
| Rate for Payer: Cash Price |
$20,218.75
|
| Rate for Payer: Cigna Commercial |
$33,563.12
|
| Rate for Payer: First Health Commercial |
$38,415.62
|
| Rate for Payer: Humana Commercial |
$34,371.88
|
| Rate for Payer: Humana KY Medicaid |
$13,906.46
|
| Rate for Payer: Kentucky WC Medicaid |
$14,047.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,158.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,842.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,131.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,185.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,180.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,901.88
|
| Rate for Payer: PHCS Commercial |
$38,820.00
|
| Rate for Payer: United Healthcare All Payer |
$35,585.00
|
|
|
SOL SYS 8IN CALC 12.0MM
|
Facility
|
IP
|
$40,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,131.25 |
| Max. Negotiated Rate |
$38,820.00 |
| Rate for Payer: Aetna Commercial |
$31,136.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,541.25
|
| Rate for Payer: Cash Price |
$20,218.75
|
| Rate for Payer: Cigna Commercial |
$33,563.12
|
| Rate for Payer: First Health Commercial |
$38,415.62
|
| Rate for Payer: Humana Commercial |
$34,371.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,158.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,842.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,131.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,180.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,901.88
|
| Rate for Payer: PHCS Commercial |
$38,820.00
|
| Rate for Payer: United Healthcare All Payer |
$35,585.00
|
|
|
SOL SYS 8 IN CALC 13.5MM
|
Facility
|
OP
|
$40,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,131.25 |
| Max. Negotiated Rate |
$38,820.00 |
| Rate for Payer: Aetna Commercial |
$31,136.88
|
| Rate for Payer: Anthem Medicaid |
$13,906.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,541.25
|
| Rate for Payer: Cash Price |
$20,218.75
|
| Rate for Payer: Cigna Commercial |
$33,563.12
|
| Rate for Payer: First Health Commercial |
$38,415.62
|
| Rate for Payer: Humana Commercial |
$34,371.88
|
| Rate for Payer: Humana KY Medicaid |
$13,906.46
|
| Rate for Payer: Kentucky WC Medicaid |
$14,047.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,158.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,842.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,131.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,185.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,180.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,901.88
|
| Rate for Payer: PHCS Commercial |
$38,820.00
|
| Rate for Payer: United Healthcare All Payer |
$35,585.00
|
|
|
SOL SYS 8 IN CALC 13.5MM
|
Facility
|
IP
|
$40,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,131.25 |
| Max. Negotiated Rate |
$38,820.00 |
| Rate for Payer: Aetna Commercial |
$31,136.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,541.25
|
| Rate for Payer: Cash Price |
$20,218.75
|
| Rate for Payer: Cigna Commercial |
$33,563.12
|
| Rate for Payer: First Health Commercial |
$38,415.62
|
| Rate for Payer: Humana Commercial |
$34,371.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,158.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,842.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,131.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,180.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,901.88
|
| Rate for Payer: PHCS Commercial |
$38,820.00
|
| Rate for Payer: United Healthcare All Payer |
$35,585.00
|
|
