|
TRIDENT ELEV RIM INSERT 36MM F
|
Facility
|
IP
|
$8,647.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.18 |
| Max. Negotiated Rate |
$8,301.39 |
| Rate for Payer: Aetna Commercial |
$6,658.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.88
|
| Rate for Payer: Cash Price |
$4,323.64
|
| Rate for Payer: Cigna Commercial |
$7,177.24
|
| Rate for Payer: First Health Commercial |
$8,214.92
|
| Rate for Payer: Humana Commercial |
$7,350.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,917.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.62
|
| Rate for Payer: PHCS Commercial |
$8,301.39
|
| Rate for Payer: United Healthcare All Payer |
$7,609.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM G
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM G
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM H
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM H
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM I
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM I
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM J
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT ELEV RIM INSERT 36MM J
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT HEAD ALUMINA 28MM -2.5
|
Facility
|
IP
|
$7,175.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.68 |
| Max. Negotiated Rate |
$6,888.58 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,596.97
|
| Rate for Payer: Cash Price |
$3,587.80
|
| Rate for Payer: Cigna Commercial |
$5,955.75
|
| Rate for Payer: First Health Commercial |
$6,816.82
|
| Rate for Payer: Humana Commercial |
$6,099.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,883.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,295.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,314.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,381.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,740.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,242.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.16
|
| Rate for Payer: PHCS Commercial |
$6,888.58
|
| Rate for Payer: United Healthcare All Payer |
$6,314.53
|
|
|
TRIDENT HEAD ALUMINA 28MM -2.5
|
Facility
|
OP
|
$7,175.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.68 |
| Max. Negotiated Rate |
$6,888.58 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Anthem Medicaid |
$2,467.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,596.97
|
| Rate for Payer: Cash Price |
$3,587.80
|
| Rate for Payer: Cigna Commercial |
$5,955.75
|
| Rate for Payer: First Health Commercial |
$6,816.82
|
| Rate for Payer: Humana Commercial |
$6,099.26
|
| Rate for Payer: Humana KY Medicaid |
$2,467.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,492.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,883.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,295.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,517.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,314.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,381.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,740.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,242.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.16
|
| Rate for Payer: PHCS Commercial |
$6,888.58
|
| Rate for Payer: United Healthcare All Payer |
$6,314.53
|
|
|
TRIDENT HEAD ALUMINA 28MM +5
|
Facility
|
IP
|
$8,077.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,423.36 |
| Max. Negotiated Rate |
$7,754.76 |
| Rate for Payer: Aetna Commercial |
$6,219.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,300.75
|
| Rate for Payer: Cash Price |
$4,038.94
|
| Rate for Payer: Cigna Commercial |
$6,704.64
|
| Rate for Payer: First Health Commercial |
$7,673.99
|
| Rate for Payer: Humana Commercial |
$6,866.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,623.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,961.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,423.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,108.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,058.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,462.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,027.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,573.74
|
| Rate for Payer: PHCS Commercial |
$7,754.76
|
| Rate for Payer: United Healthcare All Payer |
$7,108.53
|
|
|
TRIDENT HEAD ALUMINA 28MM +5
|
Facility
|
OP
|
$8,077.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,423.36 |
| Max. Negotiated Rate |
$7,754.76 |
| Rate for Payer: Aetna Commercial |
$6,219.97
|
| Rate for Payer: Anthem Medicaid |
$2,777.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,300.75
|
| Rate for Payer: Cash Price |
$4,038.94
|
| Rate for Payer: Cigna Commercial |
$6,704.64
|
| Rate for Payer: First Health Commercial |
$7,673.99
|
| Rate for Payer: Humana Commercial |
$6,866.20
|
| Rate for Payer: Humana KY Medicaid |
$2,777.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,806.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,623.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,961.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,423.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,833.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,108.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,058.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,462.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,027.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,573.74
|
| Rate for Payer: PHCS Commercial |
$7,754.76
|
| Rate for Payer: United Healthcare All Payer |
$7,108.53
|
|
|
TRIDENT HEAD ALUMINA 32MM +0
|
Facility
|
OP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem Medicaid |
$2,837.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Humana KY Medicaid |
$2,837.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
TRIDENT HEAD ALUMINA 32MM +0
|
Facility
|
IP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
TRIDENT HEAD ALUMINA 32MM -2.5
|
Facility
|
IP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
TRIDENT HEAD ALUMINA 32MM -2.5
|
Facility
|
OP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem Medicaid |
$2,837.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Humana KY Medicaid |
$2,837.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
TRIDENT HEAD ALUMINA 32MM +5
|
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 HEAD ALUMINA 32MM +5
|
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 HEMI ACE SHELL 56M F H
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT HEMI ACE SHELL 56M F H
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT HEMI ACET SHEL 52MM HA
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT HEMI ACET SHEL 52MM HA
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT HEMI ACET SHELL 50MM D
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT HEMI ACET SHELL 50MM D
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
