|
SIALOLITHOTOMY(T
|
Facility
|
IP
|
$4,493.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761T1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,347.90 |
| Max. Negotiated Rate |
$4,313.28 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.54
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cigna Commercial |
$3,729.19
|
| Rate for Payer: First Health Commercial |
$4,268.35
|
| Rate for Payer: Humana Commercial |
$3,819.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.17
|
| Rate for Payer: PHCS Commercial |
$4,313.28
|
| Rate for Payer: United Healthcare All Payer |
$3,953.84
|
|
|
SICKLE CELL SCREEN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
30000627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$5.51
|
| Rate for Payer: Humana Medicare Advantage |
$5.51
|
| Rate for Payer: Kentucky WC Medicaid |
$5.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
SICKLE CELL SCREEN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
30000627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
Sideburn LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200209
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
Sideburn LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200470
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
|
Sideburns Laser Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200208
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
SIGMA FEM ADAP +2/-2 OFFSET BO
|
Facility
|
OP
|
$3,775.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.63 |
| Max. Negotiated Rate |
$3,624.42 |
| Rate for Payer: Aetna Commercial |
$2,907.09
|
| Rate for Payer: Anthem Medicaid |
$1,298.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.84
|
| Rate for Payer: Cash Price |
$1,887.72
|
| Rate for Payer: Cigna Commercial |
$3,133.62
|
| Rate for Payer: First Health Commercial |
$3,586.67
|
| Rate for Payer: Humana Commercial |
$3,209.12
|
| Rate for Payer: Humana KY Medicaid |
$1,298.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.05
|
| Rate for Payer: PHCS Commercial |
$3,624.42
|
| Rate for Payer: United Healthcare All Payer |
$3,322.39
|
|
|
SIGMA FEM ADAP +2/-2 OFFSET BO
|
Facility
|
IP
|
$3,775.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.63 |
| Max. Negotiated Rate |
$3,624.42 |
| Rate for Payer: Aetna Commercial |
$2,907.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.84
|
| Rate for Payer: Cash Price |
$1,887.72
|
| Rate for Payer: Cigna Commercial |
$3,133.62
|
| Rate for Payer: First Health Commercial |
$3,586.67
|
| Rate for Payer: Humana Commercial |
$3,209.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.05
|
| Rate for Payer: PHCS Commercial |
$3,624.42
|
| Rate for Payer: United Healthcare All Payer |
$3,322.39
|
|
|
SIGMA FEM ADAPTER 5 DEG
|
Facility
|
OP
|
$16,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,802.46 |
| Max. Negotiated Rate |
$15,367.86 |
| Rate for Payer: Aetna Commercial |
$12,326.31
|
| Rate for Payer: Anthem Medicaid |
$5,505.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,486.39
|
| Rate for Payer: Cash Price |
$8,004.10
|
| Rate for Payer: Cigna Commercial |
$13,286.80
|
| Rate for Payer: First Health Commercial |
$15,207.78
|
| Rate for Payer: Humana Commercial |
$13,606.96
|
| Rate for Payer: Humana KY Medicaid |
$5,505.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,126.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,814.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,802.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,615.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,087.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,006.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,806.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,927.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,045.65
|
| Rate for Payer: PHCS Commercial |
$15,367.86
|
| Rate for Payer: United Healthcare All Payer |
$14,087.21
|
|
|
SIGMA FEM ADAPTER 5 DEG
|
Facility
|
IP
|
$16,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,802.46 |
| Max. Negotiated Rate |
$15,367.86 |
| Rate for Payer: Aetna Commercial |
$12,326.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,486.39
|
| Rate for Payer: Cash Price |
$8,004.10
|
| Rate for Payer: Cigna Commercial |
$13,286.80
|
| Rate for Payer: First Health Commercial |
$15,207.78
|
| Rate for Payer: Humana Commercial |
$13,606.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,126.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,814.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,802.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,087.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,006.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,806.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,927.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,045.65
|
| Rate for Payer: PHCS Commercial |
$15,367.86
|
| Rate for Payer: United Healthcare All Payer |
$14,087.21
|
|
|
SIGMA FEM ADAPTER 7 DEG
|
Facility
|
IP
|
$17,464.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,239.41 |
| Max. Negotiated Rate |
$16,766.11 |
| Rate for Payer: Aetna Commercial |
$13,447.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,622.47
|
| Rate for Payer: Cash Price |
$8,732.35
|
| Rate for Payer: Cigna Commercial |
$14,495.70
|
| Rate for Payer: First Health Commercial |
$16,591.47
|
| Rate for Payer: Humana Commercial |
$14,845.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,321.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,888.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,239.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,368.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,098.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,971.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,194.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,050.64
|
| Rate for Payer: PHCS Commercial |
$16,766.11
|
| Rate for Payer: United Healthcare All Payer |
$15,368.94
|
|
|
SIGMA FEM ADAPTER 7 DEG
|
Facility
|
OP
|
$17,464.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,239.41 |
| Max. Negotiated Rate |
$16,766.11 |
| Rate for Payer: Aetna Commercial |
$13,447.82
|
| Rate for Payer: Anthem Medicaid |
$6,006.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,622.47
|
| Rate for Payer: Cash Price |
$8,732.35
|
| Rate for Payer: Cigna Commercial |
$14,495.70
|
| Rate for Payer: First Health Commercial |
$16,591.47
|
| Rate for Payer: Humana Commercial |
$14,845.00
|
| Rate for Payer: Humana KY Medicaid |
$6,006.11
|
| Rate for Payer: Kentucky WC Medicaid |
$6,067.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,321.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,888.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,239.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,126.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,368.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,098.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,971.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,194.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,050.64
|
| Rate for Payer: PHCS Commercial |
$16,766.11
|
| Rate for Payer: United Healthcare All Payer |
$15,368.94
|
|
|
SIGMA FEM ADAPTER NEUTRAL BOLT
|
Facility
|
IP
|
$3,775.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.63 |
| Max. Negotiated Rate |
$3,624.42 |
| Rate for Payer: Aetna Commercial |
$2,907.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.84
|
| Rate for Payer: Cash Price |
$1,887.72
|
| Rate for Payer: Cigna Commercial |
$3,133.62
|
| Rate for Payer: First Health Commercial |
$3,586.67
|
| Rate for Payer: Humana Commercial |
$3,209.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.05
|
| Rate for Payer: PHCS Commercial |
$3,624.42
|
| Rate for Payer: United Healthcare All Payer |
$3,322.39
|
|
|
SIGMA FEM ADAPTER NEUTRAL BOLT
|
Facility
|
OP
|
$3,775.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.63 |
| Max. Negotiated Rate |
$3,624.42 |
| Rate for Payer: Aetna Commercial |
$2,907.09
|
| Rate for Payer: Anthem Medicaid |
$1,298.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.84
|
| Rate for Payer: Cash Price |
$1,887.72
|
| Rate for Payer: Cigna Commercial |
$3,133.62
|
| Rate for Payer: First Health Commercial |
$3,586.67
|
| Rate for Payer: Humana Commercial |
$3,209.12
|
| Rate for Payer: Humana KY Medicaid |
$1,298.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.05
|
| Rate for Payer: PHCS Commercial |
$3,624.42
|
| Rate for Payer: United Healthcare All Payer |
$3,322.39
|
|
|
SIGMA FEM POST STB CEM SZ 2.5
|
Facility
|
IP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEM SZ 2.5
|
Facility
|
OP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem Medicaid |
$5,430.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Humana KY Medicaid |
$5,430.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEM SZ2.5 R
|
Facility
|
IP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEM SZ2.5 R
|
Facility
|
OP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem Medicaid |
$5,430.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Humana KY Medicaid |
$5,430.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEM SZ 3 L
|
Facility
|
IP
|
$13,056.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,917.00 |
| Max. Negotiated Rate |
$12,534.41 |
| Rate for Payer: Aetna Commercial |
$10,053.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,184.21
|
| Rate for Payer: Cash Price |
$6,528.34
|
| Rate for Payer: Cigna Commercial |
$10,837.04
|
| Rate for Payer: First Health Commercial |
$12,403.85
|
| Rate for Payer: Humana Commercial |
$11,098.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,706.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,635.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,917.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,489.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,792.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,445.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,009.11
|
| Rate for Payer: PHCS Commercial |
$12,534.41
|
| Rate for Payer: United Healthcare All Payer |
$11,489.88
|
|
|
SIGMA FEM POST STB CEM SZ 3 L
|
Facility
|
OP
|
$13,056.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,917.00 |
| Max. Negotiated Rate |
$12,534.41 |
| Rate for Payer: Aetna Commercial |
$10,053.64
|
| Rate for Payer: Anthem Medicaid |
$4,490.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,184.21
|
| Rate for Payer: Cash Price |
$6,528.34
|
| Rate for Payer: Cigna Commercial |
$10,837.04
|
| Rate for Payer: First Health Commercial |
$12,403.85
|
| Rate for Payer: Humana Commercial |
$11,098.18
|
| Rate for Payer: Humana KY Medicaid |
$4,490.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,535.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,706.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,635.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,917.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,580.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,489.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,792.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,445.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,009.11
|
| Rate for Payer: PHCS Commercial |
$12,534.41
|
| Rate for Payer: United Healthcare All Payer |
$11,489.88
|
|
|
SIGMA FEM POST STB CEM SZ 4 L
|
Facility
|
IP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEM SZ 4 L
|
Facility
|
OP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem Medicaid |
$5,430.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Humana KY Medicaid |
$5,430.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
SIGMA FEM POST STB CEMT SZ 2 R
|
Facility
|
IP
|
$16,132.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,839.81 |
| Max. Negotiated Rate |
$15,487.39 |
| Rate for Payer: Aetna Commercial |
$12,422.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,583.51
|
| Rate for Payer: Cash Price |
$8,066.35
|
| Rate for Payer: Cigna Commercial |
$13,390.14
|
| Rate for Payer: First Health Commercial |
$15,326.07
|
| Rate for Payer: Humana Commercial |
$13,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,228.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,905.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,839.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,196.78
|
| Rate for Payer: Ohio Health Group HMO |
$12,099.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,906.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,035.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,131.56
|
| Rate for Payer: PHCS Commercial |
$15,487.39
|
| Rate for Payer: United Healthcare All Payer |
$14,196.78
|
|
|
SIGMA FEM POST STB CEMT SZ 2 R
|
Facility
|
OP
|
$16,132.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,839.81 |
| Max. Negotiated Rate |
$15,487.39 |
| Rate for Payer: Aetna Commercial |
$12,422.18
|
| Rate for Payer: Anthem Medicaid |
$5,548.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,583.51
|
| Rate for Payer: Cash Price |
$8,066.35
|
| Rate for Payer: Cigna Commercial |
$13,390.14
|
| Rate for Payer: First Health Commercial |
$15,326.07
|
| Rate for Payer: Humana Commercial |
$13,712.80
|
| Rate for Payer: Humana KY Medicaid |
$5,548.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,604.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,228.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,905.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,839.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,659.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,196.78
|
| Rate for Payer: Ohio Health Group HMO |
$12,099.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,906.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,035.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,131.56
|
| Rate for Payer: PHCS Commercial |
$15,487.39
|
| Rate for Payer: United Healthcare All Payer |
$14,196.78
|
|
|
SIGMA FEM POST STB CEMT SZ 3 R
|
Facility
|
IP
|
$13,056.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,917.00 |
| Max. Negotiated Rate |
$12,534.41 |
| Rate for Payer: Aetna Commercial |
$10,053.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,184.21
|
| Rate for Payer: Cash Price |
$6,528.34
|
| Rate for Payer: Cigna Commercial |
$10,837.04
|
| Rate for Payer: First Health Commercial |
$12,403.85
|
| Rate for Payer: Humana Commercial |
$11,098.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,706.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,635.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,917.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,489.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,792.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,445.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,009.11
|
| Rate for Payer: PHCS Commercial |
$12,534.41
|
| Rate for Payer: United Healthcare All Payer |
$11,489.88
|
|
