|
TRIDENT 0 X3 INSERT 28MM J
|
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 J
|
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 32MM B
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT 0 X3 INSERT 32MM B
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT 0 X3 INSERT 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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
|
|
|
TRIDENT 0 X3 INSERT 32MM 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 32MM J
|
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 32MM J
|
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 36MM E
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT 0 X3 INSERT 36MM E
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT 0 X3 INSERT 36MM F
|
Facility
|
IP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIDENT 0 X3 INSERT 36MM F
|
Facility
|
OP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem Medicaid |
$2,728.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Humana KY Medicaid |
$2,728.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIDENT 0 X3 INSERT 36MM G
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT 0 X3 INSERT 36MM G
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT 0 X3 INSERT 36MM H
|
Facility
|
OP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem Medicaid |
$2,728.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Humana KY Medicaid |
$2,728.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIDENT 0 X3 INSERT 36MM H
|
Facility
|
IP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIDENT 0 X3 INSERT 36MM I
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
