|
TRIDENT HEMI MULTIHOLE 62MM
|
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 64MM
|
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 64MM
|
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 66MM
|
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 66MM
|
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 68MM
|
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 68MM
|
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 70MM
|
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 70MM
|
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 72MM
|
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 72MM
|
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 74MM
|
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 74MM
|
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 INSERT 0^ 28MM CODE D
|
Facility
|
OP
|
$7,125.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.79 |
| Max. Negotiated Rate |
$6,840.92 |
| Rate for Payer: Aetna Commercial |
$5,486.99
|
| Rate for Payer: Anthem Medicaid |
$2,450.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,558.25
|
| Rate for Payer: Cash Price |
$3,562.98
|
| Rate for Payer: Cigna Commercial |
$5,914.55
|
| Rate for Payer: First Health Commercial |
$6,769.66
|
| Rate for Payer: Humana Commercial |
$6,057.07
|
| Rate for Payer: Humana KY Medicaid |
$2,450.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,475.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,843.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,258.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,137.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,499.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,270.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,344.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,700.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,916.91
|
| Rate for Payer: PHCS Commercial |
$6,840.92
|
| Rate for Payer: United Healthcare All Payer |
$6,270.84
|
|
|
TRIDENT INSERT 0^ 28MM CODE D
|
Facility
|
IP
|
$7,125.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.79 |
| Max. Negotiated Rate |
$6,840.92 |
| Rate for Payer: Aetna Commercial |
$5,486.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,558.25
|
| Rate for Payer: Cash Price |
$3,562.98
|
| Rate for Payer: Cigna Commercial |
$5,914.55
|
| Rate for Payer: First Health Commercial |
$6,769.66
|
| Rate for Payer: Humana Commercial |
$6,057.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,843.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,258.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,137.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,270.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,344.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,700.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,916.91
|
| Rate for Payer: PHCS Commercial |
$6,840.92
|
| Rate for Payer: United Healthcare All Payer |
$6,270.84
|
|
|
TRIDENT INSERT 0^ 28MM CODE E
|
Facility
|
OP
|
$8,157.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.24 |
| Max. Negotiated Rate |
$7,831.15 |
| Rate for Payer: Aetna Commercial |
$6,281.24
|
| Rate for Payer: Anthem Medicaid |
$2,805.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.81
|
| Rate for Payer: Cash Price |
$4,078.72
|
| Rate for Payer: Cigna Commercial |
$6,770.68
|
| Rate for Payer: First Health Commercial |
$7,749.58
|
| Rate for Payer: Humana Commercial |
$6,933.83
|
| Rate for Payer: Humana KY Medicaid |
$2,805.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,833.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,178.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,525.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,096.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,628.64
|
| Rate for Payer: PHCS Commercial |
$7,831.15
|
| Rate for Payer: United Healthcare All Payer |
$7,178.56
|
|
|
TRIDENT INSERT 0^ 28MM CODE E
|
Facility
|
IP
|
$8,157.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.24 |
| Max. Negotiated Rate |
$7,831.15 |
| Rate for Payer: Aetna Commercial |
$6,281.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.81
|
| Rate for Payer: Cash Price |
$4,078.72
|
| Rate for Payer: Cigna Commercial |
$6,770.68
|
| Rate for Payer: First Health Commercial |
$7,749.58
|
| Rate for Payer: Humana Commercial |
$6,933.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,178.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,525.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,096.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,628.64
|
| Rate for Payer: PHCS Commercial |
$7,831.15
|
| Rate for Payer: United Healthcare All Payer |
$7,178.56
|
|
|
TRIDENT INSERT 0^ 28MM CODE F
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE F
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE G
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE G
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE H
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE H
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE I
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
TRIDENT INSERT 0^ 28MM CODE I
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
