|
TRIDENT INSRT 10^ 36MM CODE E
|
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 INSRT 10^ 36MM CODE E
|
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 INSRT 10^ 36MM CODE G
|
Facility
|
IP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT INSRT 10^ 36MM CODE G
|
Facility
|
OP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem Medicaid |
$2,794.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Humana KY Medicaid |
$2,794.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT INSRT 10^ 36MM CODE I
|
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 I
|
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 INSRT 10^ 36MM CODE J
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT INSRT 10^ 36MM CODE J
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT PATELLA 29X9X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA 29X9X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A29X9X3
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIDENT PATELLA A29X9X3
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIDENT PATELLA A32X10X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A32X10X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A35X10X3
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIDENT PATELLA A35X10X3
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIDENT PATELLA A38X11X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A38X11X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A40X11X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT PATELLA A40X11X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIDENT X3 28MM ELE RIM C
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT X3 28MM ELE RIM C
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT X3 28MM ELE RIM D
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT X3 28MM ELE RIM D
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT X3 28MM ELE RIM E
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
