|
SIGMA RPF INSERT 2*12.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2*15MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2*15MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2*17.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2*17.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*10MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*10MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*12.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*12.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*15MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*15MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*17.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 2.5*17.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*10MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*10MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*12.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*12.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*15MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*15MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*17.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 3*17.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 4*10MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 4*10MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 4*12.5MM
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
SIGMA RPF INSERT 4*12.5MM
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
