|
PFC*SIGMA DIS AUG 8MM 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
|
|
|
PFC*SIGMA FEM POST AUG SZ 2 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*SIGMA FEM POST AUG SZ 2 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*SIGMA FEM POST AUG SZ 2 8M
|
Facility
|
IP
|
$9,785.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.61 |
| Max. Negotiated Rate |
$9,393.94 |
| Rate for Payer: Aetna Commercial |
$7,534.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,632.57
|
| Rate for Payer: Cash Price |
$4,892.68
|
| Rate for Payer: Cigna Commercial |
$8,121.84
|
| Rate for Payer: First Health Commercial |
$9,296.08
|
| Rate for Payer: Humana Commercial |
$8,317.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,023.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,221.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,611.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,828.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,513.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,751.89
|
| Rate for Payer: PHCS Commercial |
$9,393.94
|
| Rate for Payer: United Healthcare All Payer |
$8,611.11
|
|
|
PFC*SIGMA FEM POST AUG SZ 2 8M
|
Facility
|
OP
|
$9,785.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.61 |
| Max. Negotiated Rate |
$9,393.94 |
| Rate for Payer: Aetna Commercial |
$7,534.72
|
| Rate for Payer: Anthem Medicaid |
$3,365.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,632.57
|
| Rate for Payer: Cash Price |
$4,892.68
|
| Rate for Payer: Cigna Commercial |
$8,121.84
|
| Rate for Payer: First Health Commercial |
$9,296.08
|
| Rate for Payer: Humana Commercial |
$8,317.55
|
| Rate for Payer: Humana KY Medicaid |
$3,365.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,399.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,023.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,221.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,432.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,611.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,828.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,513.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,751.89
|
| Rate for Payer: PHCS Commercial |
$9,393.94
|
| Rate for Payer: United Healthcare All Payer |
$8,611.11
|
|
|
PFC*SIGMA FEM POST AUG SZ 3 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*SIGMA FEM POST AUG SZ 3 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*SIGMA FEM POST AUG SZ 3 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 FEM POST AUG SZ 3 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*SIGMA FEM POST AUG SZ 4 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*SIGMA FEM POST AUG SZ 4 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*SIGMA FEM POST AUG SZ 4 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*SIGMA FEM POST AUG SZ 4 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 FEM POSTAUG SZ 5 4MM
|
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*SIGMA FEM POSTAUG SZ 5 4MM
|
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*SIGMA FEM POSTAUG SZ 5 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*SIGMA FEM POSTAUG SZ 5 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 SIGMA FEM STEM 5 15*90MM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
PFC SIGMA FEM STEM 5 15*90MM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
PFC*SIGM DIAUG 12MM CO SZ2.5 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*SIGM DIAUG 12MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 L
|
Facility
|
OP
|
$8,975.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.51 |
| Max. Negotiated Rate |
$8,616.05 |
| Rate for Payer: Aetna Commercial |
$6,910.79
|
| Rate for Payer: Anthem Medicaid |
$3,086.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,000.54
|
| Rate for Payer: Cash Price |
$4,487.52
|
| Rate for Payer: Cigna Commercial |
$7,449.29
|
| Rate for Payer: First Health Commercial |
$8,526.30
|
| Rate for Payer: Humana Commercial |
$7,628.79
|
| Rate for Payer: Humana KY Medicaid |
$3,086.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,117.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,359.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,148.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,898.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,731.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,180.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,808.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.78
|
| Rate for Payer: PHCS Commercial |
$8,616.05
|
| Rate for Payer: United Healthcare All Payer |
$7,898.04
|
|
|
PFC*SIGM DIAUG 16MM CO SZ2.5 L
|
Facility
|
IP
|
$8,975.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.51 |
| Max. Negotiated Rate |
$8,616.05 |
| Rate for Payer: Aetna Commercial |
$6,910.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,000.54
|
| Rate for Payer: Cash Price |
$4,487.52
|
| Rate for Payer: Cigna Commercial |
$7,449.29
|
| Rate for Payer: First Health Commercial |
$8,526.30
|
| Rate for Payer: Humana Commercial |
$7,628.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,359.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,898.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,731.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,180.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,808.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.78
|
| Rate for Payer: PHCS Commercial |
$8,616.05
|
| Rate for Payer: United Healthcare All Payer |
$7,898.04
|
|
|
PFC*SIGM DIAUG 16MM CO SZ2.5 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*SIGM DIAUG 16MM CO SZ2.5 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
|
|
