|
TRIDENT INSERT 0^ 32MM CODE D
|
Facility
|
IP
|
$7,307.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,192.10 |
| Max. Negotiated Rate |
$7,014.72 |
| Rate for Payer: Aetna Commercial |
$5,626.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.46
|
| Rate for Payer: Cash Price |
$3,653.50
|
| Rate for Payer: Cigna Commercial |
$6,064.81
|
| Rate for Payer: First Health Commercial |
$6,941.65
|
| Rate for Payer: Humana Commercial |
$6,210.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.83
|
| Rate for Payer: PHCS Commercial |
$7,014.72
|
| Rate for Payer: United Healthcare All Payer |
$6,430.16
|
|
|
TRIDENT INSERT 0^ 32MM CODE D
|
Facility
|
OP
|
$7,307.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,192.10 |
| Max. Negotiated Rate |
$7,014.72 |
| Rate for Payer: Aetna Commercial |
$5,626.39
|
| Rate for Payer: Anthem Medicaid |
$2,512.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.46
|
| Rate for Payer: Cash Price |
$3,653.50
|
| Rate for Payer: Cigna Commercial |
$6,064.81
|
| Rate for Payer: First Health Commercial |
$6,941.65
|
| Rate for Payer: Humana Commercial |
$6,210.95
|
| Rate for Payer: Humana KY Medicaid |
$2,512.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.83
|
| Rate for Payer: PHCS Commercial |
$7,014.72
|
| Rate for Payer: United Healthcare All Payer |
$6,430.16
|
|
|
TRIDENT INSERT 0^ 32MM 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^ 32MM 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^ 32MM CODE F
|
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^ 32MM CODE F
|
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^ 32MM 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^ 32MM 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^ 32MM 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^ 32MM 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^ 32MM 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
|
|
|
TRIDENT INSERT 0^ 32MM 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^ 32MM CODE J
|
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^ 32MM CODE J
|
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 10^ 28MM CODE D
|
Facility
|
OP
|
$7,461.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,238.53 |
| Max. Negotiated Rate |
$7,163.29 |
| Rate for Payer: Aetna Commercial |
$5,745.56
|
| Rate for Payer: Anthem Medicaid |
$2,566.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,820.17
|
| Rate for Payer: Cash Price |
$3,730.88
|
| Rate for Payer: Cigna Commercial |
$6,193.26
|
| Rate for Payer: First Health Commercial |
$7,088.67
|
| Rate for Payer: Humana Commercial |
$6,342.50
|
| Rate for Payer: Humana KY Medicaid |
$2,566.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,118.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,506.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,566.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,596.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,969.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,491.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,148.61
|
| Rate for Payer: PHCS Commercial |
$7,163.29
|
| Rate for Payer: United Healthcare All Payer |
$6,566.35
|
|
|
TRIDENT INSERT 10^ 28MM CODE D
|
Facility
|
IP
|
$7,461.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,238.53 |
| Max. Negotiated Rate |
$7,163.29 |
| Rate for Payer: Aetna Commercial |
$5,745.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,820.17
|
| Rate for Payer: Cash Price |
$3,730.88
|
| Rate for Payer: Cigna Commercial |
$6,193.26
|
| Rate for Payer: First Health Commercial |
$7,088.67
|
| Rate for Payer: Humana Commercial |
$6,342.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,118.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,506.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,566.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,596.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,969.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,491.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,148.61
|
| Rate for Payer: PHCS Commercial |
$7,163.29
|
| Rate for Payer: United Healthcare All Payer |
$6,566.35
|
|
|
TRIDENT INSERT 10^ 28MM CODE E
|
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 10^ 28MM CODE E
|
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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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
|
|
