|
SIGMA RPF INSERT 2.5*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 2.5*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 2.5*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 2.5*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 2.5*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 2.5*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 2.5*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 2.5*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 3*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 3*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 3*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 3*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 3*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 3*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 3*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 3*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 4*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 4*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 4*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 4*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 4*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 4*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 4*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 4*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 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
|
|
