|
SIGMA RPF INSERT 4*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 4*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 4*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 4*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 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 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 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 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 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 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 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 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 6*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 6*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 6*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 6*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 6*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 6*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 6*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 6*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 SPACER SHIM ADAPTER
|
Facility
|
OP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem Medicaid |
$1,670.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Humana KY Medicaid |
$1,670.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,687.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
|
SIGMA SPACER SHIM ADAPTER
|
Facility
|
IP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
|
SIGMA TC3 FEM AUGMNT CMBO 16MM
|
Facility
|
IP
|
$7,825.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.59 |
| Max. Negotiated Rate |
$7,512.29 |
| Rate for Payer: Aetna Commercial |
$6,025.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,103.73
|
| Rate for Payer: Cash Price |
$3,912.65
|
| Rate for Payer: Cigna Commercial |
$6,495.00
|
| Rate for Payer: First Health Commercial |
$7,434.03
|
| Rate for Payer: Humana Commercial |
$6,651.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,416.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,886.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,868.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,260.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,399.46
|
| Rate for Payer: PHCS Commercial |
$7,512.29
|
| Rate for Payer: United Healthcare All Payer |
$6,886.26
|
|
|
SIGMA TC3 FEM AUGMNT CMBO 16MM
|
Facility
|
OP
|
$7,825.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.59 |
| Max. Negotiated Rate |
$7,512.29 |
| Rate for Payer: Aetna Commercial |
$6,025.48
|
| Rate for Payer: Anthem Medicaid |
$2,691.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,103.73
|
| Rate for Payer: Cash Price |
$3,912.65
|
| Rate for Payer: Cigna Commercial |
$6,495.00
|
| Rate for Payer: First Health Commercial |
$7,434.03
|
| Rate for Payer: Humana Commercial |
$6,651.51
|
| Rate for Payer: Humana KY Medicaid |
$2,691.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,416.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,745.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,886.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,868.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,260.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,399.46
|
| Rate for Payer: PHCS Commercial |
$7,512.29
|
| Rate for Payer: United Healthcare All Payer |
$6,886.26
|
|
|
SIGMA TPR STEM CEM 13MM*90MM
|
Facility
|
OP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem Medicaid |
$3,071.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Humana KY Medicaid |
$3,071.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
