|
SIGMA HP UNI FEM LM/RL SZ 1
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 1
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 2
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 2
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 3
|
Facility
|
IP
|
$19,900.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.01 |
| Max. Negotiated Rate |
$19,104.05 |
| Rate for Payer: Aetna Commercial |
$15,323.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,522.04
|
| Rate for Payer: Cash Price |
$9,950.02
|
| Rate for Payer: Cigna Commercial |
$16,517.04
|
| Rate for Payer: First Health Commercial |
$18,905.05
|
| Rate for Payer: Humana Commercial |
$16,915.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,318.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,686.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,970.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,512.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,925.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,980.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,587.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,169.02
|
| Rate for Payer: PHCS Commercial |
$19,104.05
|
| Rate for Payer: United Healthcare All Payer |
$17,512.04
|
|
|
SIGMA HP UNI FEM LM/RL SZ 3
|
Facility
|
OP
|
$19,900.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.01 |
| Max. Negotiated Rate |
$19,104.05 |
| Rate for Payer: Aetna Commercial |
$15,323.04
|
| Rate for Payer: Anthem Medicaid |
$6,843.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,522.04
|
| Rate for Payer: Cash Price |
$9,950.02
|
| Rate for Payer: Cigna Commercial |
$16,517.04
|
| Rate for Payer: First Health Commercial |
$18,905.05
|
| Rate for Payer: Humana Commercial |
$16,915.04
|
| Rate for Payer: Humana KY Medicaid |
$6,843.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,318.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,686.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,970.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,980.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,512.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,925.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,980.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,587.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,169.02
|
| Rate for Payer: PHCS Commercial |
$19,104.05
|
| Rate for Payer: United Healthcare All Payer |
$17,512.04
|
|
|
SIGMA HP UNI FEM LM/RL SZ 4
|
Facility
|
OP
|
$20,502.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,665.30 |
| Max. Negotiated Rate |
$19,682.21 |
| Rate for Payer: Aetna Commercial |
$15,786.77
|
| Rate for Payer: Anthem Medicaid |
$7,050.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,991.79
|
| Rate for Payer: Cash Price |
$10,251.15
|
| Rate for Payer: Cigna Commercial |
$17,016.91
|
| Rate for Payer: First Health Commercial |
$19,477.18
|
| Rate for Payer: Humana Commercial |
$17,426.96
|
| Rate for Payer: Humana KY Medicaid |
$7,050.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,811.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,130.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,150.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,192.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,042.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,355.71
|
| Rate for Payer: PHCS Commercial |
$19,682.21
|
| Rate for Payer: United Healthcare All Payer |
$18,042.02
|
|
|
SIGMA HP UNI FEM LM/RL SZ 4
|
Facility
|
IP
|
$20,502.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,665.30 |
| Max. Negotiated Rate |
$19,682.21 |
| Rate for Payer: Aetna Commercial |
$15,786.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,991.79
|
| Rate for Payer: Cash Price |
$10,251.15
|
| Rate for Payer: Cigna Commercial |
$17,016.91
|
| Rate for Payer: First Health Commercial |
$19,477.18
|
| Rate for Payer: Humana Commercial |
$17,426.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,811.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,130.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,150.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,042.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,355.71
|
| Rate for Payer: PHCS Commercial |
$19,682.21
|
| Rate for Payer: United Healthcare All Payer |
$18,042.02
|
|
|
SIGMA HP UNI FEM LM/RL SZ 5
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 5
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 6
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM LM/RL SZ 6
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 1
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 1
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 2
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 2
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 3
|
Facility
|
IP
|
$20,973.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.51 |
| Max. Negotiated Rate |
$20,134.22 |
| Rate for Payer: Aetna Commercial |
$16,149.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.06
|
| Rate for Payer: Cash Price |
$10,486.58
|
| Rate for Payer: Cigna Commercial |
$17,407.71
|
| Rate for Payer: First Health Commercial |
$19,924.49
|
| Rate for Payer: Humana Commercial |
$17,827.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,197.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,291.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,456.37
|
| Rate for Payer: Ohio Health Group HMO |
$15,729.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.68
|
| Rate for Payer: PHCS Commercial |
$20,134.22
|
| Rate for Payer: United Healthcare All Payer |
$18,456.37
|
|
|
SIGMA HP UNI FEM RM/LL SZ 3
|
Facility
|
OP
|
$20,973.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.51 |
| Max. Negotiated Rate |
$20,134.22 |
| Rate for Payer: Aetna Commercial |
$16,149.33
|
| Rate for Payer: Anthem Medicaid |
$7,212.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.06
|
| Rate for Payer: Cash Price |
$10,486.58
|
| Rate for Payer: Cigna Commercial |
$17,407.71
|
| Rate for Payer: First Health Commercial |
$19,924.49
|
| Rate for Payer: Humana Commercial |
$17,827.18
|
| Rate for Payer: Humana KY Medicaid |
$7,212.67
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,197.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,291.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,456.37
|
| Rate for Payer: Ohio Health Group HMO |
$15,729.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.68
|
| Rate for Payer: PHCS Commercial |
$20,134.22
|
| Rate for Payer: United Healthcare All Payer |
$18,456.37
|
|
|
SIGMA HP UNI FEM RM/LL SZ 4
|
Facility
|
OP
|
$20,502.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,665.30 |
| Max. Negotiated Rate |
$19,682.21 |
| Rate for Payer: Aetna Commercial |
$15,786.77
|
| Rate for Payer: Anthem Medicaid |
$7,050.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,991.79
|
| Rate for Payer: Cash Price |
$10,251.15
|
| Rate for Payer: Cigna Commercial |
$17,016.91
|
| Rate for Payer: First Health Commercial |
$19,477.18
|
| Rate for Payer: Humana Commercial |
$17,426.96
|
| Rate for Payer: Humana KY Medicaid |
$7,050.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,811.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,130.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,150.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,192.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,042.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,355.71
|
| Rate for Payer: PHCS Commercial |
$19,682.21
|
| Rate for Payer: United Healthcare All Payer |
$18,042.02
|
|
|
SIGMA HP UNI FEM RM/LL SZ 4
|
Facility
|
IP
|
$20,502.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,665.30 |
| Max. Negotiated Rate |
$19,682.21 |
| Rate for Payer: Aetna Commercial |
$15,786.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,991.79
|
| Rate for Payer: Cash Price |
$10,251.15
|
| Rate for Payer: Cigna Commercial |
$17,016.91
|
| Rate for Payer: First Health Commercial |
$19,477.18
|
| Rate for Payer: Humana Commercial |
$17,426.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,811.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,130.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,150.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,042.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,376.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,355.71
|
| Rate for Payer: PHCS Commercial |
$19,682.21
|
| Rate for Payer: United Healthcare All Payer |
$18,042.02
|
|
|
SIGMA HP UNI FEM RM/LL SZ 5
|
Facility
|
IP
|
$20,973.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.51 |
| Max. Negotiated Rate |
$20,134.22 |
| Rate for Payer: Aetna Commercial |
$16,149.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.06
|
| Rate for Payer: Cash Price |
$10,486.58
|
| Rate for Payer: Cigna Commercial |
$17,407.71
|
| Rate for Payer: First Health Commercial |
$19,924.49
|
| Rate for Payer: Humana Commercial |
$17,827.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,197.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,291.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,456.37
|
| Rate for Payer: Ohio Health Group HMO |
$15,729.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.68
|
| Rate for Payer: PHCS Commercial |
$20,134.22
|
| Rate for Payer: United Healthcare All Payer |
$18,456.37
|
|
|
SIGMA HP UNI FEM RM/LL SZ 5
|
Facility
|
OP
|
$20,973.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.51 |
| Max. Negotiated Rate |
$20,134.22 |
| Rate for Payer: Aetna Commercial |
$16,149.33
|
| Rate for Payer: Anthem Medicaid |
$7,212.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.06
|
| Rate for Payer: Cash Price |
$10,486.58
|
| Rate for Payer: Cigna Commercial |
$17,407.71
|
| Rate for Payer: First Health Commercial |
$19,924.49
|
| Rate for Payer: Humana Commercial |
$17,827.18
|
| Rate for Payer: Humana KY Medicaid |
$7,212.67
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,197.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,291.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,456.37
|
| Rate for Payer: Ohio Health Group HMO |
$15,729.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.68
|
| Rate for Payer: PHCS Commercial |
$20,134.22
|
| Rate for Payer: United Healthcare All Payer |
$18,456.37
|
|
|
SIGMA HP UNI FEM RM/LL SZ 6
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI FEM RM/LL SZ 6
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ1
|
Facility
|
OP
|
$11,523.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.05 |
| Max. Negotiated Rate |
$11,062.51 |
| Rate for Payer: Aetna Commercial |
$8,873.06
|
| Rate for Payer: Anthem Medicaid |
$3,962.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,988.29
|
| Rate for Payer: Cash Price |
$5,761.73
|
| Rate for Payer: Cigna Commercial |
$9,564.46
|
| Rate for Payer: First Health Commercial |
$10,947.28
|
| Rate for Payer: Humana Commercial |
$9,794.93
|
| Rate for Payer: Humana KY Medicaid |
$3,962.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,003.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,449.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,504.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,457.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,042.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,140.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,642.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,572.27
|
| Rate for Payer: PHCS Commercial |
$11,062.51
|
| Rate for Payer: United Healthcare All Payer |
$10,140.64
|
|
