|
TRIDENT ELEV RIM INSERT 36MM D
|
Facility
|
OP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem Medicaid |
$2,794.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Humana KY Medicaid |
$2,794.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM E
|
Facility
|
IP
|
$8,447.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.15 |
| Max. Negotiated Rate |
$8,109.39 |
| Rate for Payer: Aetna Commercial |
$6,504.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,588.88
|
| Rate for Payer: Cash Price |
$4,223.64
|
| Rate for Payer: Cigna Commercial |
$7,011.24
|
| Rate for Payer: First Health Commercial |
$8,024.92
|
| Rate for Payer: Humana Commercial |
$7,180.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,926.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.66
|
| Rate for Payer: PHCS Commercial |
$8,109.39
|
| Rate for Payer: United Healthcare All Payer |
$7,433.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM E
|
Facility
|
OP
|
$8,447.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.15 |
| Max. Negotiated Rate |
$8,109.39 |
| Rate for Payer: Aetna Commercial |
$6,504.41
|
| Rate for Payer: Anthem Medicaid |
$2,905.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,588.88
|
| Rate for Payer: Cash Price |
$4,223.64
|
| Rate for Payer: Cigna Commercial |
$7,011.24
|
| Rate for Payer: First Health Commercial |
$8,024.92
|
| Rate for Payer: Humana Commercial |
$7,180.19
|
| Rate for Payer: Humana KY Medicaid |
$2,905.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,934.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,926.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,963.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.66
|
| Rate for Payer: PHCS Commercial |
$8,109.39
|
| Rate for Payer: United Healthcare All Payer |
$7,433.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM F
|
Facility
|
IP
|
$8,447.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.15 |
| Max. Negotiated Rate |
$8,109.39 |
| Rate for Payer: Aetna Commercial |
$6,504.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,588.88
|
| Rate for Payer: Cash Price |
$4,223.64
|
| Rate for Payer: Cigna Commercial |
$7,011.24
|
| Rate for Payer: First Health Commercial |
$8,024.92
|
| Rate for Payer: Humana Commercial |
$7,180.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,926.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.66
|
| Rate for Payer: PHCS Commercial |
$8,109.39
|
| Rate for Payer: United Healthcare All Payer |
$7,433.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM F
|
Facility
|
OP
|
$8,447.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.15 |
| Max. Negotiated Rate |
$8,109.39 |
| Rate for Payer: Aetna Commercial |
$6,504.41
|
| Rate for Payer: Anthem Medicaid |
$2,905.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,588.88
|
| Rate for Payer: Cash Price |
$4,223.64
|
| Rate for Payer: Cigna Commercial |
$7,011.24
|
| Rate for Payer: First Health Commercial |
$8,024.92
|
| Rate for Payer: Humana Commercial |
$7,180.19
|
| Rate for Payer: Humana KY Medicaid |
$2,905.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,934.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,926.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,963.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.66
|
| Rate for Payer: PHCS Commercial |
$8,109.39
|
| Rate for Payer: United Healthcare All Payer |
$7,433.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM G
|
Facility
|
OP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem Medicaid |
$2,794.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Humana KY Medicaid |
$2,794.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM G
|
Facility
|
IP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM H
|
Facility
|
OP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem Medicaid |
$2,794.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Humana KY Medicaid |
$2,794.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM H
|
Facility
|
IP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM I
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM I
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM J
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM J
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT HEAD ALUMINA 28MM -2.5
|
Facility
|
IP
|
$6,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
TRIDENT HEAD ALUMINA 28MM -2.5
|
Facility
|
OP
|
$6,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem Medicaid |
$2,398.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Humana KY Medicaid |
$2,398.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,423.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,447.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
TRIDENT HEAD ALUMINA 28MM +5
|
Facility
|
OP
|
$7,877.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.12 |
| Max. Negotiated Rate |
$7,562.76 |
| Rate for Payer: Aetna Commercial |
$6,065.97
|
| Rate for Payer: Anthem Medicaid |
$2,709.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,144.75
|
| Rate for Payer: Cash Price |
$3,938.94
|
| Rate for Payer: Cigna Commercial |
$6,538.64
|
| Rate for Payer: First Health Commercial |
$7,483.99
|
| Rate for Payer: Humana Commercial |
$6,696.20
|
| Rate for Payer: Humana KY Medicaid |
$2,709.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,736.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,459.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,813.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,363.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,763.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,932.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,908.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,442.14
|
| Rate for Payer: PHCS Commercial |
$7,562.76
|
| Rate for Payer: United Healthcare All Payer |
$6,932.53
|
|
|
TRIDENT HEAD ALUMINA 28MM +5
|
Facility
|
IP
|
$7,877.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.12 |
| Max. Negotiated Rate |
$7,562.76 |
| Rate for Payer: Aetna Commercial |
$6,065.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,144.75
|
| Rate for Payer: Cash Price |
$3,938.94
|
| Rate for Payer: Cigna Commercial |
$6,538.64
|
| Rate for Payer: First Health Commercial |
$7,483.99
|
| Rate for Payer: Humana Commercial |
$6,696.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,459.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,813.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,932.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,908.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,442.14
|
| Rate for Payer: PHCS Commercial |
$7,562.76
|
| Rate for Payer: United Healthcare All Payer |
$6,932.53
|
|
|
TRIDENT HEAD ALUMINA 32MM +0
|
Facility
|
OP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem Medicaid |
$2,768.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Humana KY Medicaid |
$2,768.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,796.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
TRIDENT HEAD ALUMINA 32MM +0
|
Facility
|
IP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
TRIDENT HEAD ALUMINA 32MM -2.5
|
Facility
|
IP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
TRIDENT HEAD ALUMINA 32MM -2.5
|
Facility
|
OP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem Medicaid |
$2,768.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Humana KY Medicaid |
$2,768.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,796.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
TRIDENT HEAD ALUMINA 32MM +5
|
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 HEAD ALUMINA 32MM +5
|
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 HEMI ACE SHELL 56M F H
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT HEMI ACE SHELL 56M F H
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
