|
TRIDENT INSERT 0^ 28MM CODE H
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 28MM CODE H
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 28MM CODE I
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 28MM CODE I
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE D
|
Facility
|
OP
|
$7,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.91 |
| Max. Negotiated Rate |
$6,822.72 |
| Rate for Payer: Aetna Commercial |
$5,472.39
|
| Rate for Payer: Anthem Medicaid |
$2,444.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
| Rate for Payer: Cash Price |
$3,553.50
|
| Rate for Payer: Cigna Commercial |
$5,898.81
|
| Rate for Payer: First Health Commercial |
$6,751.65
|
| Rate for Payer: Humana Commercial |
$6,040.95
|
| Rate for Payer: Humana KY Medicaid |
$2,444.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,493.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$6,822.72
|
| Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
|
TRIDENT INSERT 0^ 32MM CODE D
|
Facility
|
IP
|
$7,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.91 |
| Max. Negotiated Rate |
$6,822.72 |
| Rate for Payer: Aetna Commercial |
$5,472.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
| Rate for Payer: Cash Price |
$3,553.50
|
| Rate for Payer: Cigna Commercial |
$5,898.81
|
| Rate for Payer: First Health Commercial |
$6,751.65
|
| Rate for Payer: Humana Commercial |
$6,040.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$6,822.72
|
| Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
|
TRIDENT INSERT 0^ 32MM CODE E
|
Facility
|
IP
|
$7,957.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.47 |
| Max. Negotiated Rate |
$7,639.15 |
| Rate for Payer: Aetna Commercial |
$6,127.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,206.81
|
| Rate for Payer: Cash Price |
$3,978.72
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: First Health Commercial |
$7,559.58
|
| Rate for Payer: Humana Commercial |
$6,763.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,872.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,002.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.81
|
| Rate for Payer: PHCS Commercial |
$7,639.15
|
| Rate for Payer: United Healthcare All Payer |
$7,002.56
|
|
|
TRIDENT INSERT 0^ 32MM CODE E
|
Facility
|
OP
|
$7,957.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.47 |
| Max. Negotiated Rate |
$7,639.15 |
| Rate for Payer: Aetna Commercial |
$6,127.24
|
| Rate for Payer: Anthem Medicaid |
$2,736.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,206.81
|
| Rate for Payer: Cash Price |
$3,978.72
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: First Health Commercial |
$7,559.58
|
| Rate for Payer: Humana Commercial |
$6,763.83
|
| Rate for Payer: Humana KY Medicaid |
$2,736.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,764.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,872.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,791.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,002.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.81
|
| Rate for Payer: PHCS Commercial |
$7,639.15
|
| Rate for Payer: United Healthcare All Payer |
$7,002.56
|
|
|
TRIDENT INSERT 0^ 32MM CODE F
|
Facility
|
OP
|
$7,957.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.47 |
| Max. Negotiated Rate |
$7,639.15 |
| Rate for Payer: Aetna Commercial |
$6,127.24
|
| Rate for Payer: Anthem Medicaid |
$2,736.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,206.81
|
| Rate for Payer: Cash Price |
$3,978.72
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: First Health Commercial |
$7,559.58
|
| Rate for Payer: Humana Commercial |
$6,763.83
|
| Rate for Payer: Humana KY Medicaid |
$2,736.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,764.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,872.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,791.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,002.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.81
|
| Rate for Payer: PHCS Commercial |
$7,639.15
|
| Rate for Payer: United Healthcare All Payer |
$7,002.56
|
|
|
TRIDENT INSERT 0^ 32MM CODE F
|
Facility
|
IP
|
$7,957.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.47 |
| Max. Negotiated Rate |
$7,639.15 |
| Rate for Payer: Aetna Commercial |
$6,127.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,206.81
|
| Rate for Payer: Cash Price |
$3,978.72
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: First Health Commercial |
$7,559.58
|
| Rate for Payer: Humana Commercial |
$6,763.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,872.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,002.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.81
|
| Rate for Payer: PHCS Commercial |
$7,639.15
|
| Rate for Payer: United Healthcare All Payer |
$7,002.56
|
|
|
TRIDENT INSERT 0^ 32MM CODE G
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE G
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE H
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE H
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE I
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE I
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE J
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 0^ 32MM CODE J
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 10^ 28MM CODE D
|
Facility
|
IP
|
$7,261.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.03 |
| Max. Negotiated Rate |
$6,971.29 |
| Rate for Payer: Aetna Commercial |
$5,591.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.17
|
| Rate for Payer: Cash Price |
$3,630.88
|
| Rate for Payer: Cigna Commercial |
$6,027.26
|
| Rate for Payer: First Health Commercial |
$6,898.67
|
| Rate for Payer: Humana Commercial |
$6,172.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,954.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,390.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,446.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.15
|
| Rate for Payer: PHCS Commercial |
$6,971.29
|
| Rate for Payer: United Healthcare All Payer |
$6,390.35
|
|
|
TRIDENT INSERT 10^ 28MM CODE D
|
Facility
|
OP
|
$7,261.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.03 |
| Max. Negotiated Rate |
$6,971.29 |
| Rate for Payer: Aetna Commercial |
$5,591.56
|
| Rate for Payer: Anthem Medicaid |
$2,497.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.17
|
| Rate for Payer: Cash Price |
$3,630.88
|
| Rate for Payer: Cigna Commercial |
$6,027.26
|
| Rate for Payer: First Health Commercial |
$6,898.67
|
| Rate for Payer: Humana Commercial |
$6,172.50
|
| Rate for Payer: Humana KY Medicaid |
$2,497.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,522.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,954.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,547.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,390.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,446.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.15
|
| Rate for Payer: PHCS Commercial |
$6,971.29
|
| Rate for Payer: United Healthcare All Payer |
$6,390.35
|
|
|
TRIDENT INSERT 10^ 28MM CODE E
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 10^ 28MM CODE E
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 10^ 28MM CODE F
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 10^ 28MM CODE F
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
TRIDENT INSERT 10^ 28MM CODE G
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
