|
TRIDENT HEMI ACET SHEL 52MM HA
|
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 ACET SHEL 52MM HA
|
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
|
|
|
TRIDENT HEMI ACET SHELL 50MM D
|
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
|
|
|
TRIDENT HEMI ACET SHELL 50MM D
|
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 ACET SHELL 52MM E
|
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
|
|
|
TRIDENT HEMI ACET SHELL 52MM E
|
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 ACET SHELL 56MM F
|
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 ACET SHELL 56MM F
|
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
|
|
|
TRIDENT HEMI MULTIHOLE 42MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 42MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 44MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 44MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 46MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 46MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 48MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 48MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 50MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 50MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 52MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 52MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 54MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 54MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 56MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 56MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
TRIDENT HEMI MULTIHOLE 58MM
|
Facility
|
OP
|
$473.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.53 |
| Max. Negotiated Rate |
$454.40 |
| Rate for Payer: Aetna Commercial |
$364.46
|
| Rate for Payer: Anthem Medicaid |
$162.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.20
|
| Rate for Payer: Cash Price |
$236.67
|
| Rate for Payer: Cigna Commercial |
$392.86
|
| Rate for Payer: First Health Commercial |
$449.66
|
| Rate for Payer: Humana Commercial |
$402.33
|
| Rate for Payer: Humana KY Medicaid |
$162.78
|
| Rate for Payer: Kentucky WC Medicaid |
$164.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.53
|
| Rate for Payer: Ohio Health Group HMO |
$355.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.73
|
| Rate for Payer: PHCS Commercial |
$454.40
|
| Rate for Payer: United Healthcare All Payer |
$416.53
|
|
