|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ2
|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ2
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ3
|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ3
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ4
|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ4
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ5
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ5
|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ6
|
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
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ6
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA HP UNITIB TRAY RM/LL SZ2
|
Facility
|
IP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
|
|
SIGMA HP UNITIB TRAY RM/LL SZ2
|
Facility
|
OP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem Medicaid |
$4,511.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Humana KY Medicaid |
$4,511.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,557.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,601.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ3
|
Facility
|
OP
|
$12,016.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.19 |
| Max. Negotiated Rate |
$11,536.19 |
| Rate for Payer: Aetna Commercial |
$9,252.98
|
| Rate for Payer: Anthem Medicaid |
$4,132.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,373.15
|
| Rate for Payer: Cash Price |
$6,008.43
|
| Rate for Payer: Cigna Commercial |
$9,973.99
|
| Rate for Payer: First Health Commercial |
$11,416.02
|
| Rate for Payer: Humana Commercial |
$10,214.33
|
| Rate for Payer: Humana KY Medicaid |
$4,132.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,174.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,853.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,868.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,605.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,215.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,574.84
|
| Rate for Payer: Ohio Health Group HMO |
$9,012.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.23
|
| Rate for Payer: PHCS Commercial |
$11,536.19
|
| Rate for Payer: United Healthcare All Payer |
$10,574.84
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ3
|
Facility
|
IP
|
$12,016.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.19 |
| Max. Negotiated Rate |
$11,536.19 |
| Rate for Payer: Aetna Commercial |
$9,252.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,373.15
|
| Rate for Payer: Cash Price |
$6,008.43
|
| Rate for Payer: Cigna Commercial |
$9,973.99
|
| Rate for Payer: First Health Commercial |
$11,416.02
|
| Rate for Payer: Humana Commercial |
$10,214.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,853.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,868.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,605.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,574.84
|
| Rate for Payer: Ohio Health Group HMO |
$9,012.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.23
|
| Rate for Payer: PHCS Commercial |
$11,536.19
|
| Rate for Payer: United Healthcare All Payer |
$10,574.84
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ4
|
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
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ4
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SIGMA JP PFJ TROCHLEA CEM SZ2
|
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 JP PFJ TROCHLEA CEM SZ2
|
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 RPF CEM FEM SZ 1.5 LT
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA RPF CEM FEM SZ 1.5 LT
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA RPF CEM FEM SZ 1.5 RT
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA RPF CEM FEM SZ 1.5 RT
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA RPF CEM FEM SZ 1 LT
|
Facility
|
IP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
|
SIGMA RPF CEM FEM SZ 1 LT
|
Facility
|
OP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem Medicaid |
$7,281.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Humana KY Medicaid |
$7,281.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,356.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,428.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
