|
SIGMA FEM POST STB CEMT SZ 3 R
|
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 CEMT SZ 4 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 CEMT SZ 4 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 HP FX BEAR L INS SZ4 7MM
|
Facility
|
IP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
SIGMA HP FX BEAR L INS SZ4 7MM
|
Facility
|
OP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem Medicaid |
$2,728.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Humana KY Medicaid |
$2,728.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
SIGMA HP FX BEAR R INS SZ2 7MM
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
SIGMA HP FX BEAR R INS SZ2 7MM
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
SIGMA HP FX BEAR R INS SZ3 7MM
|
Facility
|
IP
|
$8,230.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.27 |
| Max. Negotiated Rate |
$7,901.65 |
| Rate for Payer: Aetna Commercial |
$6,337.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,420.09
|
| Rate for Payer: Cash Price |
$4,115.44
|
| Rate for Payer: Cigna Commercial |
$6,831.64
|
| Rate for Payer: First Health Commercial |
$7,819.35
|
| Rate for Payer: Humana Commercial |
$6,996.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,749.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,074.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,243.18
|
| Rate for Payer: Ohio Health Group HMO |
$6,173.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,679.31
|
| Rate for Payer: PHCS Commercial |
$7,901.65
|
| Rate for Payer: United Healthcare All Payer |
$7,243.18
|
|
|
SIGMA HP FX BEAR R INS SZ3 7MM
|
Facility
|
OP
|
$8,230.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.27 |
| Max. Negotiated Rate |
$7,901.65 |
| Rate for Payer: Aetna Commercial |
$6,337.79
|
| Rate for Payer: Anthem Medicaid |
$2,830.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,420.09
|
| Rate for Payer: Cash Price |
$4,115.44
|
| Rate for Payer: Cigna Commercial |
$6,831.64
|
| Rate for Payer: First Health Commercial |
$7,819.35
|
| Rate for Payer: Humana Commercial |
$6,996.26
|
| Rate for Payer: Humana KY Medicaid |
$2,830.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,859.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,749.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,074.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,887.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,243.18
|
| Rate for Payer: Ohio Health Group HMO |
$6,173.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,679.31
|
| Rate for Payer: PHCS Commercial |
$7,901.65
|
| Rate for Payer: United Healthcare All Payer |
$7,243.18
|
|
|
SIGMA HP FX BEAR R INS SZ4 7MM
|
Facility
|
OP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem Medicaid |
$2,728.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Humana KY Medicaid |
$2,728.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
SIGMA HP FX BEAR R INS SZ4 7MM
|
Facility
|
IP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ2 L
|
Facility
|
IP
|
$24,946.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,483.88 |
| Max. Negotiated Rate |
$23,948.40 |
| Rate for Payer: Aetna Commercial |
$19,208.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,458.08
|
| Rate for Payer: Cash Price |
$12,473.12
|
| Rate for Payer: Cigna Commercial |
$20,705.39
|
| Rate for Payer: First Health Commercial |
$23,698.94
|
| Rate for Payer: Humana Commercial |
$21,204.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,483.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,952.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,709.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,957.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,212.91
|
| Rate for Payer: PHCS Commercial |
$23,948.40
|
| Rate for Payer: United Healthcare All Payer |
$21,952.70
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ2 L
|
Facility
|
OP
|
$24,946.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,483.88 |
| Max. Negotiated Rate |
$23,948.40 |
| Rate for Payer: Aetna Commercial |
$19,208.61
|
| Rate for Payer: Anthem Medicaid |
$8,579.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,458.08
|
| Rate for Payer: Cash Price |
$12,473.12
|
| Rate for Payer: Cigna Commercial |
$20,705.39
|
| Rate for Payer: First Health Commercial |
$23,698.94
|
| Rate for Payer: Humana Commercial |
$21,204.31
|
| Rate for Payer: Humana KY Medicaid |
$8,579.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8,666.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,483.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,751.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,952.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,709.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,957.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,212.91
|
| Rate for Payer: PHCS Commercial |
$23,948.40
|
| Rate for Payer: United Healthcare All Payer |
$21,952.70
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ3 R
|
Facility
|
IP
|
$24,946.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,483.88 |
| Max. Negotiated Rate |
$23,948.40 |
| Rate for Payer: Aetna Commercial |
$19,208.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,458.08
|
| Rate for Payer: Cash Price |
$12,473.12
|
| Rate for Payer: Cigna Commercial |
$20,705.39
|
| Rate for Payer: First Health Commercial |
$23,698.94
|
| Rate for Payer: Humana Commercial |
$21,204.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,483.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,952.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,709.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,957.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,212.91
|
| Rate for Payer: PHCS Commercial |
$23,948.40
|
| Rate for Payer: United Healthcare All Payer |
$21,952.70
|
|
|
SIGMA HP PFJ TRCHLEA CEM SZ3 R
|
Facility
|
OP
|
$24,946.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,483.88 |
| Max. Negotiated Rate |
$23,948.40 |
| Rate for Payer: Aetna Commercial |
$19,208.61
|
| Rate for Payer: Anthem Medicaid |
$8,579.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,458.08
|
| Rate for Payer: Cash Price |
$12,473.12
|
| Rate for Payer: Cigna Commercial |
$20,705.39
|
| Rate for Payer: First Health Commercial |
$23,698.94
|
| Rate for Payer: Humana Commercial |
$21,204.31
|
| Rate for Payer: Humana KY Medicaid |
$8,579.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8,666.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,483.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,751.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,952.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,709.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,957.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,212.91
|
| Rate for Payer: PHCS Commercial |
$23,948.40
|
| Rate for Payer: United Healthcare All Payer |
$21,952.70
|
|
|
SIGMA HP PRT KNE TROCH CUT BIT
|
Facility
|
OP
|
$2,200.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.18 |
| Max. Negotiated Rate |
$2,112.58 |
| Rate for Payer: Aetna Commercial |
$1,694.46
|
| Rate for Payer: Anthem Medicaid |
$756.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.47
|
| Rate for Payer: Cash Price |
$1,100.30
|
| Rate for Payer: Cigna Commercial |
$1,826.50
|
| Rate for Payer: First Health Commercial |
$2,090.57
|
| Rate for Payer: Humana Commercial |
$1,870.51
|
| Rate for Payer: Humana KY Medicaid |
$756.79
|
| Rate for Payer: Kentucky WC Medicaid |
$764.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,624.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.41
|
| Rate for Payer: PHCS Commercial |
$2,112.58
|
| Rate for Payer: United Healthcare All Payer |
$1,936.53
|
|
|
SIGMA HP PRT KNE TROCH CUT BIT
|
Facility
|
IP
|
$2,200.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.18 |
| Max. Negotiated Rate |
$2,112.58 |
| Rate for Payer: Aetna Commercial |
$1,694.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.47
|
| Rate for Payer: Cash Price |
$1,100.30
|
| Rate for Payer: Cigna Commercial |
$1,826.50
|
| Rate for Payer: First Health Commercial |
$2,090.57
|
| Rate for Payer: Humana Commercial |
$1,870.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,624.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.41
|
| Rate for Payer: PHCS Commercial |
$2,112.58
|
| Rate for Payer: United Healthcare All Payer |
$1,936.53
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ1
|
Facility
|
OP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem Medicaid |
$4,146.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Humana KY Medicaid |
$4,146.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ1
|
Facility
|
IP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ2
|
Facility
|
OP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem Medicaid |
$4,146.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Humana KY Medicaid |
$4,146.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ2
|
Facility
|
IP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ3
|
Facility
|
IP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ3
|
Facility
|
OP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem Medicaid |
$4,146.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Humana KY Medicaid |
$4,146.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ4
|
Facility
|
OP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem Medicaid |
$4,146.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Humana KY Medicaid |
$4,146.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
|
SIGMA HP UNI A/P 10MM LMRL SZ4
|
Facility
|
IP
|
$12,058.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.53 |
| Max. Negotiated Rate |
$11,576.10 |
| Rate for Payer: Aetna Commercial |
$9,285.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,405.58
|
| Rate for Payer: Cash Price |
$6,029.22
|
| Rate for Payer: Cigna Commercial |
$10,008.51
|
| Rate for Payer: First Health Commercial |
$11,455.52
|
| Rate for Payer: Humana Commercial |
$10,249.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,887.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,899.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,611.43
|
| Rate for Payer: Ohio Health Group HMO |
$9,043.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,646.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,490.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,320.32
|
| Rate for Payer: PHCS Commercial |
$11,576.10
|
| Rate for Payer: United Healthcare All Payer |
$10,611.43
|
|
