|
SIGMA HP FX BEAR R INS SZ2 7MM
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
SIGMA HP FX BEAR R INS SZ2 7MM
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
SIGMA HP FX BEAR R INS SZ3 7MM
|
Facility
|
OP
|
$8,030.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.02 |
| Max. Negotiated Rate |
$7,709.65 |
| Rate for Payer: Aetna Commercial |
$6,183.79
|
| Rate for Payer: Anthem Medicaid |
$2,761.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,264.09
|
| Rate for Payer: Cash Price |
$4,015.44
|
| Rate for Payer: Cigna Commercial |
$6,665.64
|
| Rate for Payer: First Health Commercial |
$7,629.35
|
| Rate for Payer: Humana Commercial |
$6,826.26
|
| Rate for Payer: Humana KY Medicaid |
$2,761.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,789.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,585.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,817.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,067.18
|
| Rate for Payer: Ohio Health Group HMO |
$6,023.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.58
|
| Rate for Payer: PHCS Commercial |
$7,709.65
|
| Rate for Payer: United Healthcare All Payer |
$7,067.18
|
|
|
SIGMA HP FX BEAR R INS SZ3 7MM
|
Facility
|
IP
|
$8,030.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.02 |
| Max. Negotiated Rate |
$7,709.65 |
| Rate for Payer: Aetna Commercial |
$6,183.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,264.09
|
| Rate for Payer: Cash Price |
$4,015.44
|
| Rate for Payer: Cigna Commercial |
$6,665.64
|
| Rate for Payer: First Health Commercial |
$7,629.35
|
| Rate for Payer: Humana Commercial |
$6,826.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,585.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,067.18
|
| Rate for Payer: Ohio Health Group HMO |
$6,023.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.58
|
| Rate for Payer: PHCS Commercial |
$7,709.65
|
| Rate for Payer: United Healthcare All Payer |
$7,067.18
|
|
|
SIGMA HP FX BEAR R INS SZ4 7MM
|
Facility
|
IP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
|
SIGMA HP FX BEAR R INS SZ4 7MM
|
Facility
|
OP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem Medicaid |
$2,660.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Humana KY Medicaid |
$2,660.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,687.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,713.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ2 L
|
Facility
|
OP
|
$24,214.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.87 |
| Max. Negotiated Rate |
$23,245.78 |
| Rate for Payer: Aetna Commercial |
$18,645.05
|
| Rate for Payer: Anthem Medicaid |
$8,327.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.19
|
| Rate for Payer: Cash Price |
$12,107.17
|
| Rate for Payer: Cigna Commercial |
$20,097.91
|
| Rate for Payer: First Health Commercial |
$23,003.63
|
| Rate for Payer: Humana Commercial |
$20,582.20
|
| Rate for Payer: Humana KY Medicaid |
$8,327.31
|
| Rate for Payer: Kentucky WC Medicaid |
$8,412.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,855.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,494.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,308.63
|
| Rate for Payer: Ohio Health Group HMO |
$18,160.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,842.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,506.45
|
| Rate for Payer: PHCS Commercial |
$23,245.78
|
| Rate for Payer: United Healthcare All Payer |
$21,308.63
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ2 L
|
Facility
|
IP
|
$24,214.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.87 |
| Max. Negotiated Rate |
$23,245.78 |
| Rate for Payer: Aetna Commercial |
$18,645.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.19
|
| Rate for Payer: Cash Price |
$12,107.17
|
| Rate for Payer: Cigna Commercial |
$20,097.91
|
| Rate for Payer: First Health Commercial |
$23,003.63
|
| Rate for Payer: Humana Commercial |
$20,582.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,855.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,308.63
|
| Rate for Payer: Ohio Health Group HMO |
$18,160.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,842.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,506.45
|
| Rate for Payer: PHCS Commercial |
$23,245.78
|
| Rate for Payer: United Healthcare All Payer |
$21,308.63
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ3 R
|
Facility
|
OP
|
$24,214.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.87 |
| Max. Negotiated Rate |
$23,245.78 |
| Rate for Payer: Aetna Commercial |
$18,645.05
|
| Rate for Payer: Anthem Medicaid |
$8,327.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.19
|
| Rate for Payer: Cash Price |
$12,107.17
|
| Rate for Payer: Cigna Commercial |
$20,097.91
|
| Rate for Payer: First Health Commercial |
$23,003.63
|
| Rate for Payer: Humana Commercial |
$20,582.20
|
| Rate for Payer: Humana KY Medicaid |
$8,327.31
|
| Rate for Payer: Kentucky WC Medicaid |
$8,412.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,855.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,494.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,308.63
|
| Rate for Payer: Ohio Health Group HMO |
$18,160.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,842.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,506.45
|
| Rate for Payer: PHCS Commercial |
$23,245.78
|
| Rate for Payer: United Healthcare All Payer |
$21,308.63
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ3 R
|
Facility
|
IP
|
$24,214.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.87 |
| Max. Negotiated Rate |
$23,245.78 |
| Rate for Payer: Aetna Commercial |
$18,645.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,887.19
|
| Rate for Payer: Cash Price |
$12,107.17
|
| Rate for Payer: Cigna Commercial |
$20,097.91
|
| Rate for Payer: First Health Commercial |
$23,003.63
|
| Rate for Payer: Humana Commercial |
$20,582.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,855.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,870.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,264.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,308.63
|
| Rate for Payer: Ohio Health Group HMO |
$18,160.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,842.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,506.45
|
| Rate for Payer: PHCS Commercial |
$23,245.78
|
| Rate for Payer: United Healthcare All Payer |
$21,308.63
|
|
|
SIGMA HP PRT KNE TROCH CUT BIT
|
Facility
|
OP
|
$2,179.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$2,092.32 |
| Rate for Payer: Aetna Commercial |
$1,678.22
|
| Rate for Payer: Anthem Medicaid |
$749.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.01
|
| Rate for Payer: Cash Price |
$1,089.75
|
| Rate for Payer: Cigna Commercial |
$1,808.98
|
| Rate for Payer: First Health Commercial |
$2,070.52
|
| Rate for Payer: Humana Commercial |
$1,852.58
|
| Rate for Payer: Humana KY Medicaid |
$749.53
|
| Rate for Payer: Kentucky WC Medicaid |
$757.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,608.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,634.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$675.64
|
| Rate for Payer: PHCS Commercial |
$2,092.32
|
| Rate for Payer: United Healthcare All Payer |
$1,917.96
|
|
|
SIGMA HP PRT KNE TROCH CUT BIT
|
Facility
|
IP
|
$2,179.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$2,092.32 |
| Rate for Payer: Aetna Commercial |
$1,678.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.01
|
| Rate for Payer: Cash Price |
$1,089.75
|
| Rate for Payer: Cigna Commercial |
$1,808.98
|
| Rate for Payer: First Health Commercial |
$2,070.52
|
| Rate for Payer: Humana Commercial |
$1,852.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,608.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,634.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$675.64
|
| Rate for Payer: PHCS Commercial |
$2,092.32
|
| Rate for Payer: United Healthcare All Payer |
$1,917.96
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ1
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ1
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ2
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ2
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ3
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ3
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ4
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ4
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ6
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ6
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM RMLL SZ1
|
Facility
|
OP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem Medicaid |
$4,062.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Humana KY Medicaid |
$4,062.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM RMLL SZ1
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
|
SIGMA HP UNI A/P 10MM RMLL SZ2
|
Facility
|
IP
|
$11,811.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.53 |
| Max. Negotiated Rate |
$11,339.33 |
| Rate for Payer: Aetna Commercial |
$9,095.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,213.20
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Cigna Commercial |
$9,803.79
|
| Rate for Payer: First Health Commercial |
$11,221.21
|
| Rate for Payer: Humana Commercial |
$10,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,685.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,717.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,394.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,858.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.66
|
| Rate for Payer: PHCS Commercial |
$11,339.33
|
| Rate for Payer: United Healthcare All Payer |
$10,394.38
|
|
