|
PFC POST AUG. COMBO 4*4MM
|
Facility
|
OP
|
$8,916.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.99 |
| Max. Negotiated Rate |
$8,559.98 |
| Rate for Payer: Aetna Commercial |
$6,865.82
|
| Rate for Payer: Anthem Medicaid |
$3,066.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,954.99
|
| Rate for Payer: Cash Price |
$4,458.32
|
| Rate for Payer: Cigna Commercial |
$7,400.82
|
| Rate for Payer: First Health Commercial |
$8,470.82
|
| Rate for Payer: Humana Commercial |
$7,579.15
|
| Rate for Payer: Humana KY Medicaid |
$3,066.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,097.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,311.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,580.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,846.65
|
| Rate for Payer: Ohio Health Group HMO |
$6,687.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,133.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,757.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,152.49
|
| Rate for Payer: PHCS Commercial |
$8,559.98
|
| Rate for Payer: United Healthcare All Payer |
$7,846.65
|
|
|
PFC POST AUG. COMBO 4*4MM
|
Facility
|
IP
|
$8,916.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.99 |
| Max. Negotiated Rate |
$8,559.98 |
| Rate for Payer: Aetna Commercial |
$6,865.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,954.99
|
| Rate for Payer: Cash Price |
$4,458.32
|
| Rate for Payer: Cigna Commercial |
$7,400.82
|
| Rate for Payer: First Health Commercial |
$8,470.82
|
| Rate for Payer: Humana Commercial |
$7,579.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,311.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,580.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,846.65
|
| Rate for Payer: Ohio Health Group HMO |
$6,687.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,133.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,757.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,152.49
|
| Rate for Payer: PHCS Commercial |
$8,559.98
|
| Rate for Payer: United Healthcare All Payer |
$7,846.65
|
|
|
PFC POST AUG. COMBO 4*8MM
|
Facility
|
IP
|
$7,307.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,192.10 |
| Max. Negotiated Rate |
$7,014.72 |
| Rate for Payer: Aetna Commercial |
$5,626.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.46
|
| Rate for Payer: Cash Price |
$3,653.50
|
| Rate for Payer: Cigna Commercial |
$6,064.81
|
| Rate for Payer: First Health Commercial |
$6,941.65
|
| Rate for Payer: Humana Commercial |
$6,210.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.83
|
| Rate for Payer: PHCS Commercial |
$7,014.72
|
| Rate for Payer: United Healthcare All Payer |
$6,430.16
|
|
|
PFC POST AUG. COMBO 4*8MM
|
Facility
|
OP
|
$7,307.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,192.10 |
| Max. Negotiated Rate |
$7,014.72 |
| Rate for Payer: Aetna Commercial |
$5,626.39
|
| Rate for Payer: Anthem Medicaid |
$2,512.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.46
|
| Rate for Payer: Cash Price |
$3,653.50
|
| Rate for Payer: Cigna Commercial |
$6,064.81
|
| Rate for Payer: First Health Commercial |
$6,941.65
|
| Rate for Payer: Humana Commercial |
$6,210.95
|
| Rate for Payer: Humana KY Medicaid |
$2,512.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.83
|
| Rate for Payer: PHCS Commercial |
$7,014.72
|
| Rate for Payer: United Healthcare All Payer |
$6,430.16
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 4M
|
Facility
|
IP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 4M
|
Facility
|
OP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem Medicaid |
$3,015.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Humana KY Medicaid |
$3,015.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 8M
|
Facility
|
IP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 8M
|
Facility
|
OP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem Medicaid |
$3,015.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Humana KY Medicaid |
$3,015.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC SIGMA+2MM FEM. BOLT
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
PFC SIGMA+2MM FEM. BOLT
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2.5
|
Facility
|
OP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem Medicaid |
$3,015.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Humana KY Medicaid |
$3,015.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2.5
|
Facility
|
IP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 L
|
Facility
|
IP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 L
|
Facility
|
OP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem Medicaid |
$2,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Humana KY Medicaid |
$2,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 R
|
Facility
|
IP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMA DI AUG 12MM CO SZ2 R
|
Facility
|
OP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem Medicaid |
$2,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Humana KY Medicaid |
$2,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 L
|
Facility
|
IP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 L
|
Facility
|
OP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem Medicaid |
$2,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Humana KY Medicaid |
$2,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 R
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 3 R
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 L
|
Facility
|
OP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem Medicaid |
$2,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Humana KY Medicaid |
$2,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 L
|
Facility
|
IP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 R
|
Facility
|
OP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem Medicaid |
$2,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Humana KY Medicaid |
$2,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 4 R
|
Facility
|
IP
|
$8,307.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,492.35 |
| Max. Negotiated Rate |
$7,975.52 |
| Rate for Payer: Aetna Commercial |
$6,397.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,480.11
|
| Rate for Payer: Cash Price |
$4,153.92
|
| Rate for Payer: Cigna Commercial |
$6,895.50
|
| Rate for Payer: First Health Commercial |
$7,892.44
|
| Rate for Payer: Humana Commercial |
$7,061.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,812.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,131.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,492.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,310.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,230.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,646.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,227.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,732.40
|
| Rate for Payer: PHCS Commercial |
$7,975.52
|
| Rate for Payer: United Healthcare All Payer |
$7,310.89
|
|
|
PFC*SIGMADI AUG 12MM CO SZ 5 L
|
Facility
|
OP
|
$7,307.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,192.10 |
| Max. Negotiated Rate |
$7,014.72 |
| Rate for Payer: Aetna Commercial |
$5,626.39
|
| Rate for Payer: Anthem Medicaid |
$2,512.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.46
|
| Rate for Payer: Cash Price |
$3,653.50
|
| Rate for Payer: Cigna Commercial |
$6,064.81
|
| Rate for Payer: First Health Commercial |
$6,941.65
|
| Rate for Payer: Humana Commercial |
$6,210.95
|
| Rate for Payer: Humana KY Medicaid |
$2,512.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.83
|
| Rate for Payer: PHCS Commercial |
$7,014.72
|
| Rate for Payer: United Healthcare All Payer |
$6,430.16
|
|
