|
TRIDENT 0 X3 INSERT 36MM I
|
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 36MM J
|
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 36MM J
|
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 10^ CONSTRAIND INSRT E
|
Facility
|
OP
|
$12,398.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.65 |
| Max. Negotiated Rate |
$11,902.88 |
| Rate for Payer: Aetna Commercial |
$9,547.10
|
| Rate for Payer: Anthem Medicaid |
$4,263.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.09
|
| Rate for Payer: Cash Price |
$6,199.42
|
| Rate for Payer: Cigna Commercial |
$10,291.03
|
| Rate for Payer: First Health Commercial |
$11,778.89
|
| Rate for Payer: Humana Commercial |
$10,539.01
|
| Rate for Payer: Humana KY Medicaid |
$4,263.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,307.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,150.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,349.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,910.97
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,786.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.19
|
| Rate for Payer: PHCS Commercial |
$11,902.88
|
| Rate for Payer: United Healthcare All Payer |
$10,910.97
|
|
|
TRIDENT 10^ CONSTRAIND INSRT E
|
Facility
|
IP
|
$12,398.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.65 |
| Max. Negotiated Rate |
$11,902.88 |
| Rate for Payer: Aetna Commercial |
$9,547.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.09
|
| Rate for Payer: Cash Price |
$6,199.42
|
| Rate for Payer: Cigna Commercial |
$10,291.03
|
| Rate for Payer: First Health Commercial |
$11,778.89
|
| Rate for Payer: Humana Commercial |
$10,539.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,150.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,910.97
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,786.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.19
|
| Rate for Payer: PHCS Commercial |
$11,902.88
|
| Rate for Payer: United Healthcare All Payer |
$10,910.97
|
|
|
TRIDENT 10^ CONSTRAIND INSRT F
|
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 10^ CONSTRAIND INSRT F
|
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 10^ CONSTRAIND INSRT G
|
Facility
|
IP
|
$12,992.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.63 |
| Max. Negotiated Rate |
$12,472.41 |
| Rate for Payer: Aetna Commercial |
$10,003.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,133.83
|
| Rate for Payer: Cash Price |
$6,496.04
|
| Rate for Payer: Cigna Commercial |
$10,783.43
|
| Rate for Payer: First Health Commercial |
$12,342.49
|
| Rate for Payer: Humana Commercial |
$11,043.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,653.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,588.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,897.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,433.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,744.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,393.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,303.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,964.54
|
| Rate for Payer: PHCS Commercial |
$12,472.41
|
| Rate for Payer: United Healthcare All Payer |
$11,433.04
|
|
|
TRIDENT 10^ CONSTRAIND INSRT G
|
Facility
|
OP
|
$12,992.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.63 |
| Max. Negotiated Rate |
$12,472.41 |
| Rate for Payer: Aetna Commercial |
$10,003.91
|
| Rate for Payer: Anthem Medicaid |
$4,467.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,133.83
|
| Rate for Payer: Cash Price |
$6,496.04
|
| Rate for Payer: Cigna Commercial |
$10,783.43
|
| Rate for Payer: First Health Commercial |
$12,342.49
|
| Rate for Payer: Humana Commercial |
$11,043.28
|
| Rate for Payer: Humana KY Medicaid |
$4,467.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,653.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,588.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,897.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,557.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,433.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,744.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,393.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,303.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,964.54
|
| Rate for Payer: PHCS Commercial |
$12,472.41
|
| Rate for Payer: United Healthcare All Payer |
$11,433.04
|
|
|
TRIDENT 10^ CONSTRAIND INSRT H
|
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 10^ CONSTRAIND INSRT H
|
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 10^ CONSTRAIND 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 10^ CONSTRAIND 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 10^ CONSTRAIND 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 10^ CONSTRAIND 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 10 X3 INSERT 28MM C
|
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 10 X3 INSERT 28MM C
|
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 10 X3 INSERT 28MM D
|
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 10 X3 INSERT 28MM D
|
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 10 X3 INSERT 28MM E
|
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 10 X3 INSERT 28MM E
|
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 10 X3 INSERT 28MM F
|
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 10 X3 INSERT 28MM F
|
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 10 X3 INSERT 28MM G
|
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 10 X3 INSERT 28MM G
|
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
|
|
