|
Sideburns Laser Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200208
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
SIGMA FEM ADAP +2/-2 OFFSET BO
|
Facility
|
IP
|
$3,857.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$3,702.79 |
| Rate for Payer: Aetna Commercial |
$2,969.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.51
|
| Rate for Payer: Cash Price |
$1,928.54
|
| Rate for Payer: Cigna Commercial |
$3,201.37
|
| Rate for Payer: First Health Commercial |
$3,664.22
|
| Rate for Payer: Humana Commercial |
$3,278.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.69
|
| Rate for Payer: PHCS Commercial |
$3,702.79
|
| Rate for Payer: United Healthcare All Payer |
$3,394.22
|
|
|
SIGMA FEM ADAP +2/-2 OFFSET BO
|
Facility
|
OP
|
$3,857.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$3,702.79 |
| Rate for Payer: Aetna Commercial |
$2,969.94
|
| Rate for Payer: Anthem Medicaid |
$1,326.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.51
|
| Rate for Payer: Cash Price |
$1,928.54
|
| Rate for Payer: Cigna Commercial |
$3,201.37
|
| Rate for Payer: First Health Commercial |
$3,664.22
|
| Rate for Payer: Humana Commercial |
$3,278.51
|
| Rate for Payer: Humana KY Medicaid |
$1,326.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.69
|
| Rate for Payer: PHCS Commercial |
$3,702.79
|
| Rate for Payer: United Healthcare All Payer |
$3,394.22
|
|
|
SIGMA FEM ADAPTER 5 DEG
|
Facility
|
IP
|
$15,494.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,014.28 |
| Max. Negotiated Rate |
$14,874.68 |
| Rate for Payer: Aetna Commercial |
$11,930.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,085.68
|
| Rate for Payer: Cash Price |
$7,747.23
|
| Rate for Payer: Cigna Commercial |
$12,860.40
|
| Rate for Payer: First Health Commercial |
$14,719.74
|
| Rate for Payer: Humana Commercial |
$13,170.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,705.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,434.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,648.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,635.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,620.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,098.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,014.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,803.28
|
| Rate for Payer: PHCS Commercial |
$14,874.68
|
| Rate for Payer: United Healthcare All Payer |
$13,635.12
|
|
|
SIGMA FEM ADAPTER 5 DEG
|
Facility
|
OP
|
$15,494.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,014.28 |
| Max. Negotiated Rate |
$14,874.68 |
| Rate for Payer: Aetna Commercial |
$11,930.73
|
| Rate for Payer: Anthem Medicaid |
$5,328.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,085.68
|
| Rate for Payer: Cash Price |
$7,747.23
|
| Rate for Payer: Cigna Commercial |
$12,860.40
|
| Rate for Payer: First Health Commercial |
$14,719.74
|
| Rate for Payer: Humana Commercial |
$13,170.29
|
| Rate for Payer: Humana KY Medicaid |
$5,328.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,382.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,705.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,434.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,648.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,435.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,635.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,620.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,098.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,014.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,803.28
|
| Rate for Payer: PHCS Commercial |
$14,874.68
|
| Rate for Payer: United Healthcare All Payer |
$13,635.12
|
|
|
SIGMA FEM ADAPTER 7 DEG
|
Facility
|
OP
|
$16,911.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$16,235.14 |
| Rate for Payer: Aetna Commercial |
$13,021.93
|
| Rate for Payer: Anthem Medicaid |
$5,815.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,191.05
|
| Rate for Payer: Cash Price |
$8,455.80
|
| Rate for Payer: Cigna Commercial |
$14,036.63
|
| Rate for Payer: First Health Commercial |
$16,066.02
|
| Rate for Payer: Humana Commercial |
$14,374.86
|
| Rate for Payer: Humana KY Medicaid |
$5,815.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,875.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,867.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,073.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,932.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,882.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,683.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,382.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,198.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,242.60
|
| Rate for Payer: PHCS Commercial |
$16,235.14
|
| Rate for Payer: United Healthcare All Payer |
$14,882.21
|
|
|
SIGMA FEM ADAPTER 7 DEG
|
Facility
|
IP
|
$16,911.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$16,235.14 |
| Rate for Payer: Aetna Commercial |
$13,021.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,191.05
|
| Rate for Payer: Cash Price |
$8,455.80
|
| Rate for Payer: Cigna Commercial |
$14,036.63
|
| Rate for Payer: First Health Commercial |
$16,066.02
|
| Rate for Payer: Humana Commercial |
$14,374.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,867.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,073.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,882.21
|
| Rate for Payer: Ohio Health Group HMO |
$12,683.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,382.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,198.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,242.60
|
| Rate for Payer: PHCS Commercial |
$16,235.14
|
| Rate for Payer: United Healthcare All Payer |
$14,882.21
|
|
|
SIGMA FEM ADAPTER NEUTRAL BOLT
|
Facility
|
OP
|
$3,857.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$3,702.79 |
| Rate for Payer: Aetna Commercial |
$2,969.94
|
| Rate for Payer: Anthem Medicaid |
$1,326.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.51
|
| Rate for Payer: Cash Price |
$1,928.54
|
| Rate for Payer: Cigna Commercial |
$3,201.37
|
| Rate for Payer: First Health Commercial |
$3,664.22
|
| Rate for Payer: Humana Commercial |
$3,278.51
|
| Rate for Payer: Humana KY Medicaid |
$1,326.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.69
|
| Rate for Payer: PHCS Commercial |
$3,702.79
|
| Rate for Payer: United Healthcare All Payer |
$3,394.22
|
|
|
SIGMA FEM ADAPTER NEUTRAL BOLT
|
Facility
|
IP
|
$3,857.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.42 |
| Max. Negotiated Rate |
$3,702.79 |
| Rate for Payer: Aetna Commercial |
$2,969.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.51
|
| Rate for Payer: Cash Price |
$1,928.54
|
| Rate for Payer: Cigna Commercial |
$3,201.37
|
| Rate for Payer: First Health Commercial |
$3,664.22
|
| Rate for Payer: Humana Commercial |
$3,278.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.69
|
| Rate for Payer: PHCS Commercial |
$3,702.79
|
| Rate for Payer: United Healthcare All Payer |
$3,394.22
|
|
|
SIGMA FEM POST STB CEM SZ 2.5
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEM SZ 2.5
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEM SZ2.5 R
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEM SZ2.5 R
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEM SZ 3 L
|
Facility
|
IP
|
$12,804.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.60 |
| Max. Negotiated Rate |
$12,292.42 |
| Rate for Payer: Aetna Commercial |
$9,859.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,987.59
|
| Rate for Payer: Cash Price |
$6,402.30
|
| Rate for Payer: Cigna Commercial |
$10,627.82
|
| Rate for Payer: First Health Commercial |
$12,164.37
|
| Rate for Payer: Humana Commercial |
$10,883.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,499.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,449.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,268.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,603.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,664.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,969.43
|
| Rate for Payer: PHCS Commercial |
$12,292.42
|
| Rate for Payer: United Healthcare All Payer |
$11,268.05
|
|
|
SIGMA FEM POST STB CEM SZ 3 L
|
Facility
|
OP
|
$12,804.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.60 |
| Max. Negotiated Rate |
$12,292.42 |
| Rate for Payer: Aetna Commercial |
$9,859.54
|
| Rate for Payer: Anthem Medicaid |
$4,403.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,987.59
|
| Rate for Payer: Cash Price |
$6,402.30
|
| Rate for Payer: Cigna Commercial |
$10,627.82
|
| Rate for Payer: First Health Commercial |
$12,164.37
|
| Rate for Payer: Humana Commercial |
$10,883.91
|
| Rate for Payer: Humana KY Medicaid |
$4,403.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,448.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,499.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,449.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,491.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,268.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,603.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,664.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,969.43
|
| Rate for Payer: PHCS Commercial |
$12,292.42
|
| Rate for Payer: United Healthcare All Payer |
$11,268.05
|
|
|
SIGMA FEM POST STB CEM SZ 4 L
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEM SZ 4 L
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEMT SZ 2 R
|
Facility
|
OP
|
$15,615.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,030.03 |
| Max. Negotiated Rate |
$14,990.98 |
| Rate for Payer: Aetna Commercial |
$12,024.01
|
| Rate for Payer: Anthem Medicaid |
$5,370.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,180.17
|
| Rate for Payer: Cash Price |
$7,807.80
|
| Rate for Payer: Cigna Commercial |
$12,960.95
|
| Rate for Payer: First Health Commercial |
$14,834.82
|
| Rate for Payer: Humana Commercial |
$13,273.26
|
| Rate for Payer: Humana KY Medicaid |
$5,370.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,424.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,804.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,524.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,684.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,477.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,741.73
|
| Rate for Payer: Ohio Health Group HMO |
$11,711.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,123.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,030.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.84
|
| Rate for Payer: PHCS Commercial |
$14,990.98
|
| Rate for Payer: United Healthcare All Payer |
$13,741.73
|
|
|
SIGMA FEM POST STB CEMT SZ 2 R
|
Facility
|
IP
|
$15,615.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,030.03 |
| Max. Negotiated Rate |
$14,990.98 |
| Rate for Payer: Aetna Commercial |
$12,024.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,180.17
|
| Rate for Payer: Cash Price |
$7,807.80
|
| Rate for Payer: Cigna Commercial |
$12,960.95
|
| Rate for Payer: First Health Commercial |
$14,834.82
|
| Rate for Payer: Humana Commercial |
$13,273.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,804.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,524.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,684.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,741.73
|
| Rate for Payer: Ohio Health Group HMO |
$11,711.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,123.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,030.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.84
|
| Rate for Payer: PHCS Commercial |
$14,990.98
|
| Rate for Payer: United Healthcare All Payer |
$13,741.73
|
|
|
SIGMA FEM POST STB CEMT SZ 3 R
|
Facility
|
OP
|
$12,804.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.60 |
| Max. Negotiated Rate |
$12,292.42 |
| Rate for Payer: Aetna Commercial |
$9,859.54
|
| Rate for Payer: Anthem Medicaid |
$4,403.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,987.59
|
| Rate for Payer: Cash Price |
$6,402.30
|
| Rate for Payer: Cigna Commercial |
$10,627.82
|
| Rate for Payer: First Health Commercial |
$12,164.37
|
| Rate for Payer: Humana Commercial |
$10,883.91
|
| Rate for Payer: Humana KY Medicaid |
$4,403.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,448.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,499.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,449.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,491.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,268.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,603.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,664.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,969.43
|
| Rate for Payer: PHCS Commercial |
$12,292.42
|
| Rate for Payer: United Healthcare All Payer |
$11,268.05
|
|
|
SIGMA FEM POST STB CEMT SZ 3 R
|
Facility
|
IP
|
$12,804.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.60 |
| Max. Negotiated Rate |
$12,292.42 |
| Rate for Payer: Aetna Commercial |
$9,859.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,987.59
|
| Rate for Payer: Cash Price |
$6,402.30
|
| Rate for Payer: Cigna Commercial |
$10,627.82
|
| Rate for Payer: First Health Commercial |
$12,164.37
|
| Rate for Payer: Humana Commercial |
$10,883.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,499.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,449.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,268.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,603.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,664.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,969.43
|
| Rate for Payer: PHCS Commercial |
$12,292.42
|
| Rate for Payer: United Healthcare All Payer |
$11,268.05
|
|
|
SIGMA FEM POST STB CEMT SZ 4 R
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA FEM POST STB CEMT SZ 4 R
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
SIGMA HP FX BEAR L INS SZ4 7MM
|
Facility
|
OP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem Medicaid |
$2,660.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Humana KY Medicaid |
$2,660.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,687.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,713.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
|
SIGMA HP FX BEAR L INS SZ4 7MM
|
Facility
|
IP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
