|
TRIDENT 0^ CONSTRAINED INSERT
|
Facility
|
IP
|
$15,694.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,708.40 |
| Max. Negotiated Rate |
$15,066.87 |
| Rate for Payer: Aetna Commercial |
$12,084.89
|
| Rate for Payer: Aetna Commercial |
$12,172.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,241.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,330.81
|
| Rate for Payer: Cash Price |
$7,847.33
|
| Rate for Payer: Cash Price |
$7,904.36
|
| Rate for Payer: Cigna Commercial |
$13,026.57
|
| Rate for Payer: Cigna Commercial |
$13,121.25
|
| Rate for Payer: First Health Commercial |
$15,018.29
|
| Rate for Payer: First Health Commercial |
$14,909.93
|
| Rate for Payer: Humana Commercial |
$13,437.42
|
| Rate for Payer: Humana Commercial |
$13,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,869.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,963.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,582.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,742.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,708.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,811.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,911.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,771.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,856.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,555.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,646.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,654.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,753.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,908.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,829.32
|
| Rate for Payer: PHCS Commercial |
$15,066.87
|
| Rate for Payer: PHCS Commercial |
$15,176.38
|
| Rate for Payer: United Healthcare All Payer |
$13,811.30
|
| Rate for Payer: United Healthcare All Payer |
$13,911.68
|
|
|
TRIDENT 0^ CONSTRAINED INSRT E
|
Facility
|
IP
|
$16,259.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,877.82 |
| Max. Negotiated Rate |
$15,609.01 |
| Rate for Payer: Aetna Commercial |
$12,519.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,682.32
|
| Rate for Payer: Cash Price |
$8,129.69
|
| Rate for Payer: Cigna Commercial |
$13,495.29
|
| Rate for Payer: First Health Commercial |
$15,446.42
|
| Rate for Payer: Humana Commercial |
$13,820.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,332.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,999.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,877.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,308.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,194.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,007.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,145.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,218.98
|
| Rate for Payer: PHCS Commercial |
$15,609.01
|
| Rate for Payer: United Healthcare All Payer |
$14,308.26
|
|
|
TRIDENT 0^ CONSTRAINED INSRT E
|
Facility
|
OP
|
$16,259.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,877.82 |
| Max. Negotiated Rate |
$15,609.01 |
| Rate for Payer: Aetna Commercial |
$12,519.73
|
| Rate for Payer: Anthem Medicaid |
$5,591.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,682.32
|
| Rate for Payer: Cash Price |
$8,129.69
|
| Rate for Payer: Cigna Commercial |
$13,495.29
|
| Rate for Payer: First Health Commercial |
$15,446.42
|
| Rate for Payer: Humana Commercial |
$13,820.48
|
| Rate for Payer: Humana KY Medicaid |
$5,591.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,648.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,332.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,999.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,877.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,703.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,308.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,194.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,007.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,145.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,218.98
|
| Rate for Payer: PHCS Commercial |
$15,609.01
|
| Rate for Payer: United Healthcare All Payer |
$14,308.26
|
|
|
TRIDENT 0^ CONSTRAINED INSRT G
|
Facility
|
OP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem Medicaid |
$4,781.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Humana KY Medicaid |
$4,781.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,830.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,877.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0^ CONSTRAINED INSRT G
|
Facility
|
IP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0^ CONSTRAINED INSRT H
|
Facility
|
OP
|
$16,308.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,892.42 |
| Max. Negotiated Rate |
$15,655.76 |
| Rate for Payer: Aetna Commercial |
$12,557.22
|
| Rate for Payer: Anthem Medicaid |
$5,608.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,720.30
|
| Rate for Payer: Cash Price |
$8,154.04
|
| Rate for Payer: Cigna Commercial |
$13,535.71
|
| Rate for Payer: First Health Commercial |
$15,492.68
|
| Rate for Payer: Humana Commercial |
$13,861.87
|
| Rate for Payer: Humana KY Medicaid |
$5,608.35
|
| Rate for Payer: Kentucky WC Medicaid |
$5,665.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,372.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,035.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,892.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,720.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,351.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,231.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,046.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,188.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,252.58
|
| Rate for Payer: PHCS Commercial |
$15,655.76
|
| Rate for Payer: United Healthcare All Payer |
$14,351.11
|
|
|
TRIDENT 0^ CONSTRAINED INSRT H
|
Facility
|
IP
|
$16,308.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,892.42 |
| Max. Negotiated Rate |
$15,655.76 |
| Rate for Payer: Aetna Commercial |
$12,557.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,720.30
|
| Rate for Payer: Cash Price |
$8,154.04
|
| Rate for Payer: Cigna Commercial |
$13,535.71
|
| Rate for Payer: First Health Commercial |
$15,492.68
|
| Rate for Payer: Humana Commercial |
$13,861.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,372.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,035.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,892.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,351.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,231.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,046.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,188.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,252.58
|
| Rate for Payer: PHCS Commercial |
$15,655.76
|
| Rate for Payer: United Healthcare All Payer |
$14,351.11
|
|
|
TRIDENT 0^ CONSTRAINED INSRT I
|
Facility
|
IP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0^ CONSTRAINED INSRT I
|
Facility
|
OP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem Medicaid |
$4,781.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Humana KY Medicaid |
$4,781.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,830.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,877.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0^ CONSTRAINED INSRT J
|
Facility
|
IP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0^ CONSTRAINED INSRT J
|
Facility
|
OP
|
$13,905.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,171.55 |
| Max. Negotiated Rate |
$13,348.97 |
| Rate for Payer: Aetna Commercial |
$10,706.99
|
| Rate for Payer: Anthem Medicaid |
$4,781.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,846.04
|
| Rate for Payer: Cash Price |
$6,952.59
|
| Rate for Payer: Cigna Commercial |
$11,541.30
|
| Rate for Payer: First Health Commercial |
$13,209.92
|
| Rate for Payer: Humana Commercial |
$11,819.40
|
| Rate for Payer: Humana KY Medicaid |
$4,781.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,830.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,262.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,171.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,877.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,236.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,428.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,124.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,097.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,594.57
|
| Rate for Payer: PHCS Commercial |
$13,348.97
|
| Rate for Payer: United Healthcare All Payer |
$12,236.56
|
|
|
TRIDENT 0 X3 INSERT 28MM C
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM C
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM D
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM D
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM E
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM E
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM F
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM F
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM G
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM G
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM H
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM H
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM I
|
Facility
|
IP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
|
TRIDENT 0 X3 INSERT 28MM I
|
Facility
|
OP
|
$8,784.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.36 |
| Max. Negotiated Rate |
$8,433.14 |
| Rate for Payer: Aetna Commercial |
$6,764.08
|
| Rate for Payer: Anthem Medicaid |
$3,021.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,851.93
|
| Rate for Payer: Cash Price |
$4,392.26
|
| Rate for Payer: Cigna Commercial |
$7,291.15
|
| Rate for Payer: First Health Commercial |
$8,345.29
|
| Rate for Payer: Humana Commercial |
$7,466.84
|
| Rate for Payer: Humana KY Medicaid |
$3,021.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,051.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,482.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,081.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,730.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,588.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,027.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,642.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.32
|
| Rate for Payer: PHCS Commercial |
$8,433.14
|
| Rate for Payer: United Healthcare All Payer |
$7,730.38
|
|
