|
SIGMA HP UNI A/P 9MM RMLL SZ 4
|
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 9MM RMLL SZ 5
|
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 9MM RMLL SZ 5
|
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 9MM RMLL SZ 6
|
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 9MM RMLL SZ 6
|
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 FEM LM/RL SZ 1
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 1
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 2
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 2
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 3
|
Facility
|
IP
|
$20,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,154.12 |
| Max. Negotiated Rate |
$19,693.20 |
| Rate for Payer: Aetna Commercial |
$15,795.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,000.73
|
| Rate for Payer: Cash Price |
$10,256.88
|
| Rate for Payer: Cigna Commercial |
$17,026.41
|
| Rate for Payer: First Health Commercial |
$19,488.06
|
| Rate for Payer: Humana Commercial |
$17,436.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,821.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,139.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,154.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,385.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,846.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,154.49
|
| Rate for Payer: PHCS Commercial |
$19,693.20
|
| Rate for Payer: United Healthcare All Payer |
$18,052.10
|
|
|
SIGMA HP UNI FEM LM/RL SZ 3
|
Facility
|
OP
|
$20,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,154.12 |
| Max. Negotiated Rate |
$19,693.20 |
| Rate for Payer: Aetna Commercial |
$15,795.59
|
| Rate for Payer: Anthem Medicaid |
$7,054.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,000.73
|
| Rate for Payer: Cash Price |
$10,256.88
|
| Rate for Payer: Cigna Commercial |
$17,026.41
|
| Rate for Payer: First Health Commercial |
$19,488.06
|
| Rate for Payer: Humana Commercial |
$17,436.69
|
| Rate for Payer: Humana KY Medicaid |
$7,054.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,126.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,821.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,139.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,154.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,196.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,385.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,846.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,154.49
|
| Rate for Payer: PHCS Commercial |
$19,693.20
|
| Rate for Payer: United Healthcare All Payer |
$18,052.10
|
|
|
SIGMA HP UNI FEM LM/RL SZ 4
|
Facility
|
OP
|
$21,132.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,339.75 |
| Max. Negotiated Rate |
$20,287.20 |
| Rate for Payer: Aetna Commercial |
$16,272.02
|
| Rate for Payer: Anthem Medicaid |
$7,267.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,483.35
|
| Rate for Payer: Cash Price |
$10,566.25
|
| Rate for Payer: Cigna Commercial |
$17,539.97
|
| Rate for Payer: First Health Commercial |
$20,075.88
|
| Rate for Payer: Humana Commercial |
$17,962.62
|
| Rate for Payer: Humana KY Medicaid |
$7,267.47
|
| Rate for Payer: Kentucky WC Medicaid |
$7,341.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,328.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,595.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,339.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,413.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,596.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,849.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,906.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,581.42
|
| Rate for Payer: PHCS Commercial |
$20,287.20
|
| Rate for Payer: United Healthcare All Payer |
$18,596.60
|
|
|
SIGMA HP UNI FEM LM/RL SZ 4
|
Facility
|
IP
|
$21,132.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,339.75 |
| Max. Negotiated Rate |
$20,287.20 |
| Rate for Payer: Aetna Commercial |
$16,272.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,483.35
|
| Rate for Payer: Cash Price |
$10,566.25
|
| Rate for Payer: Cigna Commercial |
$17,539.97
|
| Rate for Payer: First Health Commercial |
$20,075.88
|
| Rate for Payer: Humana Commercial |
$17,962.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,328.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,595.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,339.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,596.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,849.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,906.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,581.42
|
| Rate for Payer: PHCS Commercial |
$20,287.20
|
| Rate for Payer: United Healthcare All Payer |
$18,596.60
|
|
|
SIGMA HP UNI FEM LM/RL SZ 5
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 5
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 6
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM LM/RL SZ 6
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM RM/LL SZ 1
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM RM/LL SZ 1
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM RM/LL SZ 2
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM RM/LL SZ 2
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
SIGMA HP UNI FEM RM/LL SZ 3
|
Facility
|
IP
|
$21,616.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,484.88 |
| Max. Negotiated Rate |
$20,751.60 |
| Rate for Payer: Aetna Commercial |
$16,644.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,860.67
|
| Rate for Payer: Cash Price |
$10,808.12
|
| Rate for Payer: Cigna Commercial |
$17,941.49
|
| Rate for Payer: First Health Commercial |
$20,535.44
|
| Rate for Payer: Humana Commercial |
$18,373.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,952.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,484.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.21
|
| Rate for Payer: PHCS Commercial |
$20,751.60
|
| Rate for Payer: United Healthcare All Payer |
$19,022.30
|
|
|
SIGMA HP UNI FEM RM/LL SZ 3
|
Facility
|
OP
|
$21,616.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,484.88 |
| Max. Negotiated Rate |
$20,751.60 |
| Rate for Payer: Aetna Commercial |
$16,644.51
|
| Rate for Payer: Anthem Medicaid |
$7,433.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,860.67
|
| Rate for Payer: Cash Price |
$10,808.12
|
| Rate for Payer: Cigna Commercial |
$17,941.49
|
| Rate for Payer: First Health Commercial |
$20,535.44
|
| Rate for Payer: Humana Commercial |
$18,373.81
|
| Rate for Payer: Humana KY Medicaid |
$7,433.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,509.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,952.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,484.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,582.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.21
|
| Rate for Payer: PHCS Commercial |
$20,751.60
|
| Rate for Payer: United Healthcare All Payer |
$19,022.30
|
|
|
SIGMA HP UNI FEM RM/LL SZ 4
|
Facility
|
IP
|
$21,132.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,339.75 |
| Max. Negotiated Rate |
$20,287.20 |
| Rate for Payer: Aetna Commercial |
$16,272.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,483.35
|
| Rate for Payer: Cash Price |
$10,566.25
|
| Rate for Payer: Cigna Commercial |
$17,539.97
|
| Rate for Payer: First Health Commercial |
$20,075.88
|
| Rate for Payer: Humana Commercial |
$17,962.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,328.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,595.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,339.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,596.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,849.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,906.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,581.42
|
| Rate for Payer: PHCS Commercial |
$20,287.20
|
| Rate for Payer: United Healthcare All Payer |
$18,596.60
|
|
|
SIGMA HP UNI FEM RM/LL SZ 4
|
Facility
|
OP
|
$21,132.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,339.75 |
| Max. Negotiated Rate |
$20,287.20 |
| Rate for Payer: Aetna Commercial |
$16,272.02
|
| Rate for Payer: Anthem Medicaid |
$7,267.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,483.35
|
| Rate for Payer: Cash Price |
$10,566.25
|
| Rate for Payer: Cigna Commercial |
$17,539.97
|
| Rate for Payer: First Health Commercial |
$20,075.88
|
| Rate for Payer: Humana Commercial |
$17,962.62
|
| Rate for Payer: Humana KY Medicaid |
$7,267.47
|
| Rate for Payer: Kentucky WC Medicaid |
$7,341.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,328.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,595.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,339.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,413.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,596.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,849.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,906.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,581.42
|
| Rate for Payer: PHCS Commercial |
$20,287.20
|
| Rate for Payer: United Healthcare All Payer |
$18,596.60
|
|
