|
PFC*SIGMADI AUG 16MM CO SZ 3 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 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 16MM 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 16MM 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 16MM 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 16MM 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 16MM 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 16MM 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 4MM SZ 3 L
|
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 4MM SZ 3 L
|
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 4MM SZ 3 R
|
Facility
|
IP
|
$9,074.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.67 |
| Max. Negotiated Rate |
$8,711.38 |
| Rate for Payer: Aetna Commercial |
$6,987.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,077.99
|
| Rate for Payer: Cash Price |
$4,537.18
|
| Rate for Payer: Cigna Commercial |
$7,531.71
|
| Rate for Payer: First Health Commercial |
$8,620.63
|
| Rate for Payer: Humana Commercial |
$7,713.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,440.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,696.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,722.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,985.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,805.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,814.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,813.05
|
| Rate for Payer: PHCS Commercial |
$8,711.38
|
| Rate for Payer: United Healthcare All Payer |
$7,985.43
|
|
|
PFC*SIGMA DI AUG 4MM SZ 3 R
|
Facility
|
OP
|
$9,074.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.67 |
| Max. Negotiated Rate |
$8,711.38 |
| Rate for Payer: Aetna Commercial |
$6,987.25
|
| Rate for Payer: Anthem Medicaid |
$3,120.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,077.99
|
| Rate for Payer: Cash Price |
$4,537.18
|
| Rate for Payer: Cigna Commercial |
$7,531.71
|
| Rate for Payer: First Health Commercial |
$8,620.63
|
| Rate for Payer: Humana Commercial |
$7,713.20
|
| Rate for Payer: Humana KY Medicaid |
$3,120.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,152.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,440.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,696.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,722.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,183.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,985.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,805.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,814.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,813.05
|
| Rate for Payer: PHCS Commercial |
$8,711.38
|
| Rate for Payer: United Healthcare All Payer |
$7,985.43
|
|
|
PFC*SIGMA DI AUG 8MM 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*SIGMA DI AUG 8MM 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*SIGMA DI AUG 8MM SZ 3 R
|
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 8MM SZ 3 R
|
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 DIS AUG 4MM SZ 2.5 L
|
Facility
|
IP
|
$9,585.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.10 |
| Max. Negotiated Rate |
$9,201.94 |
| Rate for Payer: Aetna Commercial |
$7,380.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,476.57
|
| Rate for Payer: Cash Price |
$4,792.68
|
| Rate for Payer: Cigna Commercial |
$7,955.84
|
| Rate for Payer: First Health Commercial |
$9,106.08
|
| Rate for Payer: Humana Commercial |
$8,147.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,435.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.46
|
| Rate for Payer: PHCS Commercial |
$9,201.94
|
| Rate for Payer: United Healthcare All Payer |
$8,435.11
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 2.5 L
|
Facility
|
OP
|
$9,585.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.10 |
| Max. Negotiated Rate |
$9,201.94 |
| Rate for Payer: Aetna Commercial |
$7,380.72
|
| Rate for Payer: Anthem Medicaid |
$3,296.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,476.57
|
| Rate for Payer: Cash Price |
$4,792.68
|
| Rate for Payer: Cigna Commercial |
$7,955.84
|
| Rate for Payer: First Health Commercial |
$9,106.08
|
| Rate for Payer: Humana Commercial |
$8,147.55
|
| Rate for Payer: Humana KY Medicaid |
$3,296.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,329.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,435.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.46
|
| Rate for Payer: PHCS Commercial |
$9,201.94
|
| Rate for Payer: United Healthcare All Payer |
$8,435.11
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 2.5 R
|
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 DIS AUG 4MM SZ 2.5 R
|
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 DIS AUG 4MM SZ 2 L
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 2 L
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 2 R
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 2 R
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
PFC*SIGMA DIS AUG 4MM SZ 4 L
|
Facility
|
OP
|
$9,585.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.10 |
| Max. Negotiated Rate |
$9,201.94 |
| Rate for Payer: Aetna Commercial |
$7,380.72
|
| Rate for Payer: Anthem Medicaid |
$3,296.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,476.57
|
| Rate for Payer: Cash Price |
$4,792.68
|
| Rate for Payer: Cigna Commercial |
$7,955.84
|
| Rate for Payer: First Health Commercial |
$9,106.08
|
| Rate for Payer: Humana Commercial |
$8,147.55
|
| Rate for Payer: Humana KY Medicaid |
$3,296.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,329.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,435.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.46
|
| Rate for Payer: PHCS Commercial |
$9,201.94
|
| Rate for Payer: United Healthcare All Payer |
$8,435.11
|
|
