|
SOL SYS 8 IN CALC 15.0MM
|
Facility
|
OP
|
$71,192.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,357.76 |
| Max. Negotiated Rate |
$68,344.84 |
| Rate for Payer: Aetna Commercial |
$54,818.26
|
| Rate for Payer: Anthem Medicaid |
$24,483.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,530.18
|
| Rate for Payer: Cash Price |
$35,596.27
|
| Rate for Payer: Cigna Commercial |
$59,089.81
|
| Rate for Payer: First Health Commercial |
$67,632.91
|
| Rate for Payer: Humana Commercial |
$60,513.66
|
| Rate for Payer: Humana KY Medicaid |
$24,483.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24,732.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,377.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,540.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,357.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,649.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,954.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,937.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,122.85
|
| Rate for Payer: PHCS Commercial |
$68,344.84
|
| Rate for Payer: United Healthcare All Payer |
$62,649.44
|
|
|
SOL SYS 8 IN CALC 15.0MM
|
Facility
|
IP
|
$71,192.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,357.76 |
| Max. Negotiated Rate |
$68,344.84 |
| Rate for Payer: Aetna Commercial |
$54,818.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,530.18
|
| Rate for Payer: Cash Price |
$35,596.27
|
| Rate for Payer: Cigna Commercial |
$59,089.81
|
| Rate for Payer: First Health Commercial |
$67,632.91
|
| Rate for Payer: Humana Commercial |
$60,513.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,377.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,540.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,357.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,649.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,954.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,937.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,122.85
|
| Rate for Payer: PHCS Commercial |
$68,344.84
|
| Rate for Payer: United Healthcare All Payer |
$62,649.44
|
|
|
SOL SYS 8IN CALC 16.5MM
|
Facility
|
IP
|
$71,192.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,357.76 |
| Max. Negotiated Rate |
$68,344.84 |
| Rate for Payer: Aetna Commercial |
$54,818.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,530.18
|
| Rate for Payer: Cash Price |
$35,596.27
|
| Rate for Payer: Cigna Commercial |
$59,089.81
|
| Rate for Payer: First Health Commercial |
$67,632.91
|
| Rate for Payer: Humana Commercial |
$60,513.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,377.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,540.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,357.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,649.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,954.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,937.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,122.85
|
| Rate for Payer: PHCS Commercial |
$68,344.84
|
| Rate for Payer: United Healthcare All Payer |
$62,649.44
|
|
|
SOL SYS 8IN CALC 16.5MM
|
Facility
|
OP
|
$71,192.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,357.76 |
| Max. Negotiated Rate |
$68,344.84 |
| Rate for Payer: Aetna Commercial |
$54,818.26
|
| Rate for Payer: Anthem Medicaid |
$24,483.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,530.18
|
| Rate for Payer: Cash Price |
$35,596.27
|
| Rate for Payer: Cigna Commercial |
$59,089.81
|
| Rate for Payer: First Health Commercial |
$67,632.91
|
| Rate for Payer: Humana Commercial |
$60,513.66
|
| Rate for Payer: Humana KY Medicaid |
$24,483.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24,732.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,377.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,540.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,357.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,974.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,649.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,954.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,937.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,122.85
|
| Rate for Payer: PHCS Commercial |
$68,344.84
|
| Rate for Payer: United Healthcare All Payer |
$62,649.44
|
|
|
SOL SYS 8IN CALC 18.0MM
|
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 18.0MM
|
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 19.5 MM
|
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 19.5 MM
|
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 STEM LG STAT L 13.5M
|
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 8 STEM LG STAT L 13.5M
|
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 STEM LG STAT L 16.5M
|
Facility
|
IP
|
$85,268.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,580.64 |
| Max. Negotiated Rate |
$81,858.05 |
| Rate for Payer: Aetna Commercial |
$65,656.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,509.66
|
| Rate for Payer: Cash Price |
$42,634.40
|
| Rate for Payer: Cigna Commercial |
$70,773.10
|
| Rate for Payer: First Health Commercial |
$81,005.36
|
| Rate for Payer: Humana Commercial |
$72,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,920.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,580.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,036.54
|
| Rate for Payer: Ohio Health Group HMO |
$63,951.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,215.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,183.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,835.47
|
| Rate for Payer: PHCS Commercial |
$81,858.05
|
| Rate for Payer: United Healthcare All Payer |
$75,036.54
|
|
|
SOL SYS 8 STEM LG STAT L 16.5M
|
Facility
|
OP
|
$85,268.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,580.64 |
| Max. Negotiated Rate |
$81,858.05 |
| Rate for Payer: Aetna Commercial |
$65,656.98
|
| Rate for Payer: Anthem Medicaid |
$29,323.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,509.66
|
| Rate for Payer: Cash Price |
$42,634.40
|
| Rate for Payer: Cigna Commercial |
$70,773.10
|
| Rate for Payer: First Health Commercial |
$81,005.36
|
| Rate for Payer: Humana Commercial |
$72,478.48
|
| Rate for Payer: Humana KY Medicaid |
$29,323.94
|
| Rate for Payer: Kentucky WC Medicaid |
$29,622.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,920.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,580.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,912.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,036.54
|
| Rate for Payer: Ohio Health Group HMO |
$63,951.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,215.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,183.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,835.47
|
| Rate for Payer: PHCS Commercial |
$81,858.05
|
| Rate for Payer: United Healthcare All Payer |
$75,036.54
|
|
|
SOL SYS 8 STEM LG STAT R 13.5M
|
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 8 STEM LG STAT R 13.5M
|
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 STEM LG STAT R 15.0M
|
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 8 STEM LG STAT R 15.0M
|
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 STEM LG STAT R 18.0M
|
Facility
|
IP
|
$85,268.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,580.64 |
| Max. Negotiated Rate |
$81,858.05 |
| Rate for Payer: Aetna Commercial |
$65,656.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,509.66
|
| Rate for Payer: Cash Price |
$42,634.40
|
| Rate for Payer: Cigna Commercial |
$70,773.10
|
| Rate for Payer: First Health Commercial |
$81,005.36
|
| Rate for Payer: Humana Commercial |
$72,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,920.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,580.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,036.54
|
| Rate for Payer: Ohio Health Group HMO |
$63,951.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,215.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,183.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,835.47
|
| Rate for Payer: PHCS Commercial |
$81,858.05
|
| Rate for Payer: United Healthcare All Payer |
$75,036.54
|
|
|
SOL SYS 8 STEM LG STAT R 18.0M
|
Facility
|
OP
|
$85,268.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,580.64 |
| Max. Negotiated Rate |
$81,858.05 |
| Rate for Payer: Aetna Commercial |
$65,656.98
|
| Rate for Payer: Anthem Medicaid |
$29,323.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,509.66
|
| Rate for Payer: Cash Price |
$42,634.40
|
| Rate for Payer: Cigna Commercial |
$70,773.10
|
| Rate for Payer: First Health Commercial |
$81,005.36
|
| Rate for Payer: Humana Commercial |
$72,478.48
|
| Rate for Payer: Humana KY Medicaid |
$29,323.94
|
| Rate for Payer: Kentucky WC Medicaid |
$29,622.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,920.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,580.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,912.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,036.54
|
| Rate for Payer: Ohio Health Group HMO |
$63,951.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,215.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,183.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,835.47
|
| Rate for Payer: PHCS Commercial |
$81,858.05
|
| Rate for Payer: United Healthcare All Payer |
$75,036.54
|
|
|
SOL SYS 8 ST LG STATURE SZ13.5
|
Facility
|
IP
|
$67,777.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,333.22 |
| Max. Negotiated Rate |
$65,066.30 |
| Rate for Payer: Aetna Commercial |
$52,188.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,866.37
|
| Rate for Payer: Cash Price |
$33,888.70
|
| Rate for Payer: Cigna Commercial |
$56,255.24
|
| Rate for Payer: First Health Commercial |
$64,388.53
|
| Rate for Payer: Humana Commercial |
$57,610.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,577.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,019.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,333.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,644.11
|
| Rate for Payer: Ohio Health Group HMO |
$50,833.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,221.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58,966.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,766.41
|
| Rate for Payer: PHCS Commercial |
$65,066.30
|
| Rate for Payer: United Healthcare All Payer |
$59,644.11
|
|
|
SOL SYS 8 ST LG STATURE SZ13.5
|
Facility
|
OP
|
$67,777.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,333.22 |
| Max. Negotiated Rate |
$65,066.30 |
| Rate for Payer: Aetna Commercial |
$52,188.60
|
| Rate for Payer: Anthem Medicaid |
$23,308.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,866.37
|
| Rate for Payer: Cash Price |
$33,888.70
|
| Rate for Payer: Cigna Commercial |
$56,255.24
|
| Rate for Payer: First Health Commercial |
$64,388.53
|
| Rate for Payer: Humana Commercial |
$57,610.79
|
| Rate for Payer: Humana KY Medicaid |
$23,308.65
|
| Rate for Payer: Kentucky WC Medicaid |
$23,545.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,577.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,019.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,333.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,776.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,644.11
|
| Rate for Payer: Ohio Health Group HMO |
$50,833.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,221.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58,966.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,766.41
|
| Rate for Payer: PHCS Commercial |
$65,066.30
|
| Rate for Payer: United Healthcare All Payer |
$59,644.11
|
|
|
SOL SYS 8 ST LG STATURE SZ16.5
|
Facility
|
IP
|
$78,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,463.66 |
| Max. Negotiated Rate |
$75,083.71 |
| Rate for Payer: Aetna Commercial |
$60,223.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,005.52
|
| Rate for Payer: Cash Price |
$39,106.10
|
| Rate for Payer: Cigna Commercial |
$64,916.13
|
| Rate for Payer: First Health Commercial |
$74,301.59
|
| Rate for Payer: Humana Commercial |
$66,480.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,720.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,826.74
|
| Rate for Payer: Ohio Health Group HMO |
$58,659.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,044.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,966.42
|
| Rate for Payer: PHCS Commercial |
$75,083.71
|
| Rate for Payer: United Healthcare All Payer |
$68,826.74
|
|
|
SOL SYS 8 ST LG STATURE SZ16.5
|
Facility
|
OP
|
$78,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,463.66 |
| Max. Negotiated Rate |
$75,083.71 |
| Rate for Payer: Aetna Commercial |
$60,223.39
|
| Rate for Payer: Anthem Medicaid |
$26,897.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,005.52
|
| Rate for Payer: Cash Price |
$39,106.10
|
| Rate for Payer: Cigna Commercial |
$64,916.13
|
| Rate for Payer: First Health Commercial |
$74,301.59
|
| Rate for Payer: Humana Commercial |
$66,480.37
|
| Rate for Payer: Humana KY Medicaid |
$26,897.18
|
| Rate for Payer: Kentucky WC Medicaid |
$27,170.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,720.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,436.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,826.74
|
| Rate for Payer: Ohio Health Group HMO |
$58,659.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,044.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,966.42
|
| Rate for Payer: PHCS Commercial |
$75,083.71
|
| Rate for Payer: United Healthcare All Payer |
$68,826.74
|
|
|
SOL SYS 8 ST SMLL STATURSZ12.0
|
Facility
|
IP
|
$76,338.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,901.64 |
| Max. Negotiated Rate |
$73,285.25 |
| Rate for Payer: Aetna Commercial |
$58,780.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,544.26
|
| Rate for Payer: Cash Price |
$38,169.40
|
| Rate for Payer: Cigna Commercial |
$63,361.20
|
| Rate for Payer: First Health Commercial |
$72,521.86
|
| Rate for Payer: Humana Commercial |
$64,887.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,597.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,338.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,901.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,178.14
|
| Rate for Payer: Ohio Health Group HMO |
$57,254.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,071.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,414.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,673.77
|
| Rate for Payer: PHCS Commercial |
$73,285.25
|
| Rate for Payer: United Healthcare All Payer |
$67,178.14
|
|
|
SOL SYS 8 ST SMLL STATURSZ12.0
|
Facility
|
OP
|
$76,338.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,901.64 |
| Max. Negotiated Rate |
$73,285.25 |
| Rate for Payer: Aetna Commercial |
$58,780.88
|
| Rate for Payer: Anthem Medicaid |
$26,252.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,544.26
|
| Rate for Payer: Cash Price |
$38,169.40
|
| Rate for Payer: Cigna Commercial |
$63,361.20
|
| Rate for Payer: First Health Commercial |
$72,521.86
|
| Rate for Payer: Humana Commercial |
$64,887.98
|
| Rate for Payer: Humana KY Medicaid |
$26,252.91
|
| Rate for Payer: Kentucky WC Medicaid |
$26,520.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,597.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,338.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,901.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,779.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,178.14
|
| Rate for Payer: Ohio Health Group HMO |
$57,254.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,071.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,414.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,673.77
|
| Rate for Payer: PHCS Commercial |
$73,285.25
|
| Rate for Payer: United Healthcare All Payer |
$67,178.14
|
|
|
SOL SYS 8 ST SMLL STATURSZ13.5
|
Facility
|
IP
|
$78,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,463.66 |
| Max. Negotiated Rate |
$75,083.71 |
| Rate for Payer: Aetna Commercial |
$60,223.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,005.52
|
| Rate for Payer: Cash Price |
$39,106.10
|
| Rate for Payer: Cigna Commercial |
$64,916.13
|
| Rate for Payer: First Health Commercial |
$74,301.59
|
| Rate for Payer: Humana Commercial |
$66,480.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,720.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,826.74
|
| Rate for Payer: Ohio Health Group HMO |
$58,659.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,044.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,966.42
|
| Rate for Payer: PHCS Commercial |
$75,083.71
|
| Rate for Payer: United Healthcare All Payer |
$68,826.74
|
|
