|
PFC*SIGMA FEM POST AUG SZ 3 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 FEM POST AUG SZ 3 8M
|
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 4 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 4 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 4 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 FEM POST AUG SZ 4 8M
|
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 POSTAUG SZ 5 4MM
|
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 FEM POSTAUG SZ 5 4MM
|
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 POSTAUG SZ 5 8MM
|
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 POSTAUG SZ 5 8MM
|
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 FEM STEM 5 15*90MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
PFC SIGMA FEM STEM 5 15*90MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
PFC*SIGM DIAUG 12MM CO SZ2.5 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*SIGM DIAUG 12MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 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 SIG RPF CEM FEM SZ 4N LT
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
PFC SIG RPF CEM FEM SZ 4N LT
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
PFC SIG RPF CEM FEM SZ 4N RT
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
PFC SIG RPF CEM FEM SZ 4N RT
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
PF Eyelid Full Face-PP#2/3 25%
|
Professional
|
Both
|
$765.00
|
|
| Hospital Charge Code |
22200522
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$535.50
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
|
|
PF EYELIDS
|
Professional
|
Both
|
$1,200.00
|
|
| Hospital Charge Code |
22200313
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
PF Eyelids Full Face-PP#1 50%
|
Professional
|
Both
|
$1,530.00
|
|
| Hospital Charge Code |
22200314
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,530.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Multiplan PHCS |
$918.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,071.00
|
| Rate for Payer: UHCCP Medicaid |
$535.50
|
|
