|
SIGMA RPF INSERT 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 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 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 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 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 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 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 6*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 6*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 6*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 6*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 6*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 6*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 6*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 6*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 SPACER SHIM ADAPTER
|
Facility
|
IP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
SIGMA SPACER SHIM ADAPTER
|
Facility
|
OP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem Medicaid |
$1,673.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Humana KY Medicaid |
$1,673.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,690.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,707.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
SIGMA TC3 FEM AUGMNT CMBO 16MM
|
Facility
|
IP
|
$7,625.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.29 |
| Max. Negotiated Rate |
$7,320.29 |
| Rate for Payer: Aetna Commercial |
$5,871.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,947.73
|
| Rate for Payer: Cash Price |
$3,812.65
|
| Rate for Payer: Cigna Commercial |
$6,329.00
|
| Rate for Payer: First Health Commercial |
$7,244.04
|
| Rate for Payer: Humana Commercial |
$6,481.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,252.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,627.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,710.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,718.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.84
|
| Rate for Payer: PHCS Commercial |
$7,320.29
|
| Rate for Payer: United Healthcare All Payer |
$6,710.26
|
|
|
SIGMA TC3 FEM AUGMNT CMBO 16MM
|
Facility
|
OP
|
$7,625.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.29 |
| Max. Negotiated Rate |
$7,320.29 |
| Rate for Payer: Aetna Commercial |
$5,871.48
|
| Rate for Payer: Anthem Medicaid |
$2,622.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,947.73
|
| Rate for Payer: Cash Price |
$3,812.65
|
| Rate for Payer: Cigna Commercial |
$6,329.00
|
| Rate for Payer: First Health Commercial |
$7,244.04
|
| Rate for Payer: Humana Commercial |
$6,481.50
|
| Rate for Payer: Humana KY Medicaid |
$2,622.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,649.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,252.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,627.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,674.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,710.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,718.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.84
|
| Rate for Payer: PHCS Commercial |
$7,320.29
|
| Rate for Payer: United Healthcare All Payer |
$6,710.26
|
|
|
SIGMA TPR STEM CEM 13MM*90MM
|
Facility
|
IP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
SIGMA TPR STEM CEM 13MM*90MM
|
Facility
|
OP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem Medicaid |
$3,002.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Humana KY Medicaid |
$3,002.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,033.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,062.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Anthem Medicaid |
$159.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$195.53
|
| Rate for Payer: Healthspan PPO |
$181.67
|
| Rate for Payer: Humana Medicaid |
$159.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.94
|
| Rate for Payer: Molina Healthcare Passport |
$159.75
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.35
|
|
|
SIGMOIDOSCOPY & DECOMPRESS
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
76101886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
SIGMOIDOSCOPY & DECOMPRESS(P
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 45337
|
| Hospital Charge Code |
761P1886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Anthem Medicaid |
$159.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$195.53
|
| Rate for Payer: Healthspan PPO |
$181.67
|
| Rate for Payer: Humana Medicaid |
$159.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.94
|
| Rate for Payer: Molina Healthcare Passport |
$159.75
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.35
|
|
