PFC*SIG FEM POST AUG SZ 2.5 8M
|
Facility
|
OP
|
$8,567.55
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,113.78 |
Max. Negotiated Rate |
$8,224.85 |
Rate for Payer: Aetna Commercial |
$6,597.01
|
Rate for Payer: Anthem Medicaid |
$2,946.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
Rate for Payer: Cash Price |
$4,283.77
|
Rate for Payer: Cigna Commercial |
$7,111.07
|
Rate for Payer: First Health Commercial |
$8,139.17
|
Rate for Payer: Humana Commercial |
$7,282.42
|
Rate for Payer: Humana KY Medicaid |
$2,946.38
|
Rate for Payer: Kentucky WC Medicaid |
$2,976.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
Rate for Payer: Molina Healthcare Medicaid |
$3,005.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
Rate for Payer: PHCS Commercial |
$8,224.85
|
Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
PFC SIGMA+2MM FEM. BOLT
|
Facility
|
IP
|
$3,390.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$440.70 |
Max. Negotiated Rate |
$3,254.40 |
Rate for Payer: Aetna Commercial |
$2,610.30
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
Rate for Payer: Cash Price |
$1,695.00
|
Rate for Payer: Cigna Commercial |
$2,813.70
|
Rate for Payer: First Health Commercial |
$3,220.50
|
Rate for Payer: Humana Commercial |
$2,881.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
Rate for Payer: PHCS Commercial |
$3,254.40
|
Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
PFC SIGMA+2MM FEM. BOLT
|
Facility
|
OP
|
$3,390.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$440.70 |
Max. Negotiated Rate |
$3,254.40 |
Rate for Payer: Aetna Commercial |
$2,610.30
|
Rate for Payer: Anthem Medicaid |
$1,165.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
Rate for Payer: Cash Price |
$1,695.00
|
Rate for Payer: Cigna Commercial |
$2,813.70
|
Rate for Payer: First Health Commercial |
$3,220.50
|
Rate for Payer: Humana Commercial |
$2,881.50
|
Rate for Payer: Humana KY Medicaid |
$1,165.82
|
Rate for Payer: Kentucky WC Medicaid |
$1,177.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,189.21
|
Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
Rate for Payer: PHCS Commercial |
$3,254.40
|
Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
PFC*SIGMA DI AUG 12MM CO SZ2.5
|
Facility
|
IP
|
$8,567.55
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,113.78 |
Max. Negotiated Rate |
$8,224.85 |
Rate for Payer: Aetna Commercial |
$6,597.01
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
Rate for Payer: Cash Price |
$4,283.77
|
Rate for Payer: Cigna Commercial |
$7,111.07
|
Rate for Payer: First Health Commercial |
$8,139.17
|
Rate for Payer: Humana Commercial |
$7,282.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
Rate for Payer: PHCS Commercial |
$8,224.85
|
Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
PFC*SIGMA DI AUG 12MM CO SZ2.5
|
Facility
|
OP
|
$8,567.55
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,113.78 |
Max. Negotiated Rate |
$8,224.85 |
Rate for Payer: Aetna Commercial |
$6,597.01
|
Rate for Payer: Anthem Medicaid |
$2,946.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
Rate for Payer: Cash Price |
$4,283.77
|
Rate for Payer: Cigna Commercial |
$7,111.07
|
Rate for Payer: First Health Commercial |
$8,139.17
|
Rate for Payer: Humana Commercial |
$7,282.42
|
Rate for Payer: Humana KY Medicaid |
$2,946.38
|
Rate for Payer: Kentucky WC Medicaid |
$2,976.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
Rate for Payer: Molina Healthcare Medicaid |
$3,005.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
Rate for Payer: PHCS Commercial |
$8,224.85
|
Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 L
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 L
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 R
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 R
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 L
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 L
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 R
|
Facility
|
IP
|
$8,435.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,096.63 |
Max. Negotiated Rate |
$8,098.18 |
Rate for Payer: Aetna Commercial |
$6,495.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
Rate for Payer: Cash Price |
$4,217.80
|
Rate for Payer: Cigna Commercial |
$7,001.55
|
Rate for Payer: First Health Commercial |
$8,013.82
|
Rate for Payer: Humana Commercial |
$7,170.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
Rate for Payer: PHCS Commercial |
$8,098.18
|
Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 R
|
Facility
|
OP
|
$8,435.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,096.63 |
Max. Negotiated Rate |
$8,098.18 |
Rate for Payer: Aetna Commercial |
$6,495.41
|
Rate for Payer: Anthem Medicaid |
$2,901.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
Rate for Payer: Cash Price |
$4,217.80
|
Rate for Payer: Cigna Commercial |
$7,001.55
|
Rate for Payer: First Health Commercial |
$8,013.82
|
Rate for Payer: Humana Commercial |
$7,170.26
|
Rate for Payer: Humana KY Medicaid |
$2,901.00
|
Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
Rate for Payer: PHCS Commercial |
$8,098.18
|
Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 L
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 L
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 R
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 R
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 12MM CO SZ 5 L
|
Facility
|
IP
|
$7,107.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$923.91 |
Max. Negotiated Rate |
$6,822.72 |
Rate for Payer: Aetna Commercial |
$5,472.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
Rate for Payer: Cash Price |
$3,553.50
|
Rate for Payer: Cigna Commercial |
$5,898.81
|
Rate for Payer: First Health Commercial |
$6,751.65
|
Rate for Payer: Humana Commercial |
$6,040.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
Rate for Payer: PHCS Commercial |
$6,822.72
|
Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
PFC*SIGMADI AUG 12MM CO SZ 5 L
|
Facility
|
OP
|
$7,107.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$923.91 |
Max. Negotiated Rate |
$6,822.72 |
Rate for Payer: Aetna Commercial |
$5,472.39
|
Rate for Payer: Anthem Medicaid |
$2,444.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
Rate for Payer: Cash Price |
$3,553.50
|
Rate for Payer: Cigna Commercial |
$5,898.81
|
Rate for Payer: First Health Commercial |
$6,751.65
|
Rate for Payer: Humana Commercial |
$6,040.95
|
Rate for Payer: Humana KY Medicaid |
$2,444.10
|
Rate for Payer: Kentucky WC Medicaid |
$2,468.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
Rate for Payer: Molina Healthcare Medicaid |
$2,493.14
|
Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
Rate for Payer: PHCS Commercial |
$6,822.72
|
Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
PFC*SIGMA DI AUG 16MM CO SZ2 L
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 16MM CO SZ2 L
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 16MM CO SZ2 R
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMA DI AUG 16MM CO SZ2 R
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 16MM CO SZ 3 L
|
Facility
|
OP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem Medicaid |
$2,788.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Humana KY Medicaid |
$2,788.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,816.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Molina Healthcare Medicaid |
$2,844.23
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|
PFC*SIGMADI AUG 16MM CO SZ 3 L
|
Facility
|
IP
|
$8,107.83
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,054.02 |
Max. Negotiated Rate |
$7,783.52 |
Rate for Payer: Aetna Commercial |
$6,243.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,324.11
|
Rate for Payer: Cash Price |
$4,053.92
|
Rate for Payer: Cigna Commercial |
$6,729.50
|
Rate for Payer: First Health Commercial |
$7,702.44
|
Rate for Payer: Humana Commercial |
$6,891.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,648.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,134.89
|
Rate for Payer: Ohio Health Group HMO |
$6,080.87
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,621.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,513.43
|
Rate for Payer: PHCS Commercial |
$7,783.52
|
Rate for Payer: United Healthcare All Payer |
$7,134.89
|
|