|
TRIDENT HEMI ACET SHELL 52MM E
|
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 52MM E
|
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 56MM F
|
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 56MM F
|
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 MULTIHOLE 42MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 42MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 44MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 44MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 46MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 46MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 48MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 48MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 50MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 50MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 52MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 52MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 54MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 54MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 56MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 56MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
TRIDENT HEMI MULTIHOLE 58MM
|
Facility
|
IP
|
$477.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.25 |
| Max. Negotiated Rate |
$458.40 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.45
|
| Rate for Payer: Cash Price |
$238.75
|
| Rate for Payer: Cigna Commercial |
$396.32
|
| Rate for Payer: First Health Commercial |
$453.62
|
| Rate for Payer: Humana Commercial |
$405.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.20
|
| Rate for Payer: Ohio Health Group HMO |
$358.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.48
|
| Rate for Payer: PHCS Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Payer |
$420.20
|
|
|
TRIDENT HEMI MULTIHOLE 58MM
|
Facility
|
OP
|
$477.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.25 |
| Max. Negotiated Rate |
$458.40 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Anthem Medicaid |
$164.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.45
|
| Rate for Payer: Cash Price |
$238.75
|
| Rate for Payer: Cigna Commercial |
$396.32
|
| Rate for Payer: First Health Commercial |
$453.62
|
| Rate for Payer: Humana Commercial |
$405.88
|
| Rate for Payer: Humana KY Medicaid |
$164.21
|
| Rate for Payer: Kentucky WC Medicaid |
$165.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.20
|
| Rate for Payer: Ohio Health Group HMO |
$358.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.48
|
| Rate for Payer: PHCS Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Payer |
$420.20
|
|
|
TRIDENT HEMI MULTIHOLE 60MM
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIDENT HEMI MULTIHOLE 60MM
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIDENT HEMI MULTIHOLE 62MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
