|
SIGMA HP UNI FEM RM/LL SZ 5
|
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 5
|
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 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 RM/LL 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 TIB TRAY LMRL SZ1
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ1
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ2
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ2
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ3
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ3
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ4
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ4
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ5
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ5
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ6
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRAY LMRL SZ6
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNITIB TRAY RM/LL SZ2
|
Facility
|
OP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem Medicaid |
$4,598.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Humana KY Medicaid |
$4,598.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,645.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,691.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
|
SIGMA HP UNITIB TRAY RM/LL SZ2
|
Facility
|
IP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ3
|
Facility
|
OP
|
$12,264.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,679.39 |
| Max. Negotiated Rate |
$11,774.04 |
| Rate for Payer: Aetna Commercial |
$9,443.76
|
| Rate for Payer: Anthem Medicaid |
$4,217.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,566.40
|
| Rate for Payer: Cash Price |
$6,132.31
|
| Rate for Payer: Cigna Commercial |
$10,179.63
|
| Rate for Payer: First Health Commercial |
$11,651.39
|
| Rate for Payer: Humana Commercial |
$10,424.93
|
| Rate for Payer: Humana KY Medicaid |
$4,217.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,260.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,056.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,051.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,679.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,302.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,792.87
|
| Rate for Payer: Ohio Health Group HMO |
$9,198.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,811.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,670.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,462.59
|
| Rate for Payer: PHCS Commercial |
$11,774.04
|
| Rate for Payer: United Healthcare All Payer |
$10,792.87
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ3
|
Facility
|
IP
|
$12,264.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,679.39 |
| Max. Negotiated Rate |
$11,774.04 |
| Rate for Payer: Aetna Commercial |
$9,443.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,566.40
|
| Rate for Payer: Cash Price |
$6,132.31
|
| Rate for Payer: Cigna Commercial |
$10,179.63
|
| Rate for Payer: First Health Commercial |
$11,651.39
|
| Rate for Payer: Humana Commercial |
$10,424.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,056.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,051.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,679.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,792.87
|
| Rate for Payer: Ohio Health Group HMO |
$9,198.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,811.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,670.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,462.59
|
| Rate for Payer: PHCS Commercial |
$11,774.04
|
| Rate for Payer: United Healthcare All Payer |
$10,792.87
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ4
|
Facility
|
OP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem Medicaid |
$4,047.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Humana KY Medicaid |
$4,047.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA HP UNI TIB TRY RM/LL SZ4
|
Facility
|
IP
|
$11,768.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.55 |
| Max. Negotiated Rate |
$11,297.77 |
| Rate for Payer: Aetna Commercial |
$9,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,179.44
|
| Rate for Payer: Cash Price |
$5,884.26
|
| Rate for Payer: Cigna Commercial |
$9,767.86
|
| Rate for Payer: First Health Commercial |
$11,180.08
|
| Rate for Payer: Humana Commercial |
$10,003.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,650.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,685.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,356.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,826.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,414.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,120.27
|
| Rate for Payer: PHCS Commercial |
$11,297.77
|
| Rate for Payer: United Healthcare All Payer |
$10,356.29
|
|
|
SIGMA JP PFJ TROCHLEA CEM SZ2
|
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 JP PFJ TROCHLEA CEM SZ2
|
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 RPF CEM FEM SZ 1.5 LT
|
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
|
|
