|
PFC*SIGMA DIS AUG 4MM SZ 4 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 4 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 4 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 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*SIGMA DIS AUG 4MM 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 DIS AUG 8MM SZ 2.5 L
|
Facility
|
IP
|
$8,775.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.76 |
| Max. Negotiated Rate |
$8,424.05 |
| Rate for Payer: Aetna Commercial |
$6,756.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,844.54
|
| Rate for Payer: Cash Price |
$4,387.52
|
| Rate for Payer: Cigna Commercial |
$7,283.29
|
| Rate for Payer: First Health Commercial |
$8,336.30
|
| Rate for Payer: Humana Commercial |
$7,458.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,195.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,722.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,581.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.27
|
| Rate for Payer: PHCS Commercial |
$8,424.05
|
| Rate for Payer: United Healthcare All Payer |
$7,722.04
|
|
|
PFC*SIGMA DIS AUG 8MM SZ 2.5 L
|
Facility
|
OP
|
$8,775.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.76 |
| Max. Negotiated Rate |
$8,424.05 |
| Rate for Payer: Aetna Commercial |
$6,756.79
|
| Rate for Payer: Anthem Medicaid |
$3,017.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,844.54
|
| Rate for Payer: Cash Price |
$4,387.52
|
| Rate for Payer: Cigna Commercial |
$7,283.29
|
| Rate for Payer: First Health Commercial |
$8,336.30
|
| Rate for Payer: Humana Commercial |
$7,458.79
|
| Rate for Payer: Humana KY Medicaid |
$3,017.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,195.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,722.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,581.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.27
|
| Rate for Payer: PHCS Commercial |
$8,424.05
|
| Rate for Payer: United Healthcare All Payer |
$7,722.04
|
|
|
PFC*SIGMA DIS AUG 8MM 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 8MM 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 8MM SZ 2 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 DIS AUG 8MM SZ 2 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 DIS AUG 8MM SZ 2 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 8MM SZ 2 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 8MM SZ 4 L
|
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*SIGMA DIS AUG 8MM SZ 4 L
|
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*SIGMA DIS AUG 8MM SZ 4 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 8MM SZ 4 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 8MM 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*SIGMA DIS AUG 8MM 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 FEM POST AUG SZ 2 4M
|
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 FEM POST AUG SZ 2 4M
|
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 FEM POST AUG SZ 2 8M
|
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 FEM POST AUG SZ 2 8M
|
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 FEM POST AUG SZ 3 4M
|
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 FEM POST AUG SZ 3 4M
|
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
|
|
