|
SIGMA RPF CEM FEM SZ 1.5 LT
|
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 RPF CEM FEM SZ 1.5 RT
|
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 RPF CEM FEM SZ 1.5 RT
|
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 RPF CEM FEM SZ 1 LT
|
Facility
|
OP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem Medicaid |
$7,505.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Humana KY Medicaid |
$7,505.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,655.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
SIGMA RPF CEM FEM SZ 1 LT
|
Facility
|
IP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
SIGMA RPF CEM FEM SZ 1 RT
|
Facility
|
IP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
SIGMA RPF CEM FEM SZ 1 RT
|
Facility
|
OP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem Medicaid |
$7,505.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Humana KY Medicaid |
$7,505.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,655.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
SIGMA RPF CEM FEM SZ 2.5 LT
|
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 RPF CEM FEM SZ 2.5 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
|
|
|
SIGMA RPF CEM FEM SZ 2.5 RT
|
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 RPF CEM FEM SZ 2.5 RT
|
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 RPF CEM FEM SZ 2 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
|
|
|
SIGMA RPF CEM FEM SZ 2 LT
|
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 RPF CEM FEM SZ 2 RT
|
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 RPF CEM FEM SZ 2 RT
|
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 RPF CEM FEM SZ 3 LT
|
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 RPF CEM FEM SZ 3 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
|
|
|
SIGMA RPF CEM FEM SZ 3 RT
|
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 RPF CEM FEM SZ 3 RT
|
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 RPF CEM FEM SZ 4 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
|
|
|
SIGMA RPF CEM FEM SZ 4 LT
|
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 RPF CEM FEM SZ 4 RT
|
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 RPF CEM FEM SZ 4 RT
|
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 RPF CEM FEM SZ 5 LT
|
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 RPF CEM FEM SZ 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
|
|
