|
SIGMA RPF CEM FEM SZ 6 RT
|
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 RPF INSERT 1*10MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*10MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*12.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*12.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*15MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*15MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*17.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1*17.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*10MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*10MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*12.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*12.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*15MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*15MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*17.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 1.5*17.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*10MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*10MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*12.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*12.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*15MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*15MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*17.5MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
SIGMA RPF INSERT 2*17.5MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
