|
TRIDENT INSERT 10^ 28MM 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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 32MM CODE D
|
Facility
|
IP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
|
TRIDENT INSERT 10^ 32MM CODE D
|
Facility
|
OP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem Medicaid |
$2,564.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Humana KY Medicaid |
$2,564.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,590.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,616.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
|
TRIDENT INSERT 10^ 32MM CODE E
|
Facility
|
OP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem Medicaid |
$2,263.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Humana KY Medicaid |
$2,263.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,286.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,308.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE E
|
Facility
|
IP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE F
|
Facility
|
OP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem Medicaid |
$2,263.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Humana KY Medicaid |
$2,263.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,286.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,308.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE F
|
Facility
|
IP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE G
|
Facility
|
OP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem Medicaid |
$2,880.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Humana KY Medicaid |
$2,880.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,910.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE G
|
Facility
|
IP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE H
|
Facility
|
IP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE H
|
Facility
|
OP
|
$6,581.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.58 |
| Max. Negotiated Rate |
$6,318.14 |
| Rate for Payer: Aetna Commercial |
$5,067.68
|
| Rate for Payer: Anthem Medicaid |
$2,263.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,133.49
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cigna Commercial |
$5,462.56
|
| Rate for Payer: First Health Commercial |
$6,252.33
|
| Rate for Payer: Humana Commercial |
$5,594.19
|
| Rate for Payer: Humana KY Medicaid |
$2,263.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,286.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,396.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,857.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,308.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,791.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,936.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.23
|
| Rate for Payer: PHCS Commercial |
$6,318.14
|
| Rate for Payer: United Healthcare All Payer |
$5,791.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE I
|
Facility
|
IP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE I
|
Facility
|
OP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem Medicaid |
$2,880.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Humana KY Medicaid |
$2,880.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,910.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE J
|
Facility
|
IP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE J
|
Facility
|
OP
|
$8,377.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.04 |
| Max. Negotiated Rate |
$8,042.11 |
| Rate for Payer: Aetna Commercial |
$6,450.44
|
| Rate for Payer: Anthem Medicaid |
$2,880.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,534.22
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna Commercial |
$6,953.08
|
| Rate for Payer: First Health Commercial |
$7,958.34
|
| Rate for Payer: Humana Commercial |
$7,120.62
|
| Rate for Payer: Humana KY Medicaid |
$2,880.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,910.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,869.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,182.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,513.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.93
|
| Rate for Payer: PHCS Commercial |
$8,042.11
|
| Rate for Payer: United Healthcare All Payer |
$7,371.94
|
|
|
TRIDENT INSERT 10^ 36MM CODE F
|
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 INSERT 10^ 36MM CODE F
|
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 INSERT 10^ 36MM CODE H
|
Facility
|
IP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
|
TRIDENT INSERT 10^ 36MM CODE H
|
Facility
|
OP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem Medicaid |
$2,564.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Humana KY Medicaid |
$2,564.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,590.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,616.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
|
TRIDENT INSRT 10^ 36MM CODE D
|
Facility
|
OP
|
$9,176.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.95 |
| Max. Negotiated Rate |
$8,809.49 |
| Rate for Payer: Aetna Commercial |
$7,065.94
|
| Rate for Payer: Anthem Medicaid |
$3,155.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,157.71
|
| Rate for Payer: Cash Price |
$4,588.27
|
| Rate for Payer: Cigna Commercial |
$7,616.54
|
| Rate for Payer: First Health Commercial |
$8,717.72
|
| Rate for Payer: Humana Commercial |
$7,800.07
|
| Rate for Payer: Humana KY Medicaid |
$3,155.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,187.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,524.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,772.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,752.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,219.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,075.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,882.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,835.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,192.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,844.73
|
| Rate for Payer: PHCS Commercial |
$8,809.49
|
| Rate for Payer: United Healthcare All Payer |
$8,075.36
|
|
|
TRIDENT INSRT 10^ 36MM CODE D
|
Facility
|
IP
|
$9,176.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.95 |
| Max. Negotiated Rate |
$8,809.49 |
| Rate for Payer: Aetna Commercial |
$7,065.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,157.71
|
| Rate for Payer: Cash Price |
$4,588.27
|
| Rate for Payer: Cigna Commercial |
$7,616.54
|
| Rate for Payer: First Health Commercial |
$8,717.72
|
| Rate for Payer: Humana Commercial |
$7,800.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,524.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,772.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,752.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,075.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,882.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,835.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,192.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,844.73
|
| Rate for Payer: PHCS Commercial |
$8,809.49
|
| Rate for Payer: United Healthcare All Payer |
$8,075.36
|
|
