|
TRIDENT 10 X3 INSERT 28MM F
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM F
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM G
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM G
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM H
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM H
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT 10 X3 INSERT 28MM I
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 28MM I
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 28MM J
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 28MM J
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM D
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM D
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM E
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM E
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM F
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM F
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM G
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM G
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM H
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM H
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM I
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM I
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM J
|
Facility
|
IP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 32MM J
|
Facility
|
OP
|
$8,584.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.99 |
| Max. Negotiated Rate |
$8,241.14 |
| Rate for Payer: Aetna Commercial |
$6,610.08
|
| Rate for Payer: Anthem Medicaid |
$2,952.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.93
|
| Rate for Payer: Cash Price |
$4,292.26
|
| Rate for Payer: Cigna Commercial |
$7,125.15
|
| Rate for Payer: First Health Commercial |
$8,155.29
|
| Rate for Payer: Humana Commercial |
$7,296.84
|
| Rate for Payer: Humana KY Medicaid |
$2,952.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.20
|
| Rate for Payer: PHCS Commercial |
$8,241.14
|
| Rate for Payer: United Healthcare All Payer |
$7,554.38
|
|
|
TRIDENT 10 X3 INSERT 36MM E
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
