|
TRIDENT INSERT 10^ 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 10^ 32MM CODE D
|
Facility
|
IP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
TRIDENT INSERT 10^ 32MM CODE D
|
Facility
|
OP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem Medicaid |
$2,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Humana KY Medicaid |
$2,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,660.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,686.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
TRIDENT INSERT 10^ 32MM CODE E
|
Facility
|
OP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem Medicaid |
$2,332.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Humana KY Medicaid |
$2,332.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,355.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,378.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE E
|
Facility
|
IP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE F
|
Facility
|
OP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem Medicaid |
$2,332.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Humana KY Medicaid |
$2,332.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,355.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,378.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE F
|
Facility
|
IP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE G
|
Facility
|
IP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE G
|
Facility
|
OP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem Medicaid |
$2,949.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Humana KY Medicaid |
$2,949.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE H
|
Facility
|
OP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem Medicaid |
$2,332.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Humana KY Medicaid |
$2,332.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,355.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,378.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE H
|
Facility
|
IP
|
$6,781.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.42 |
| Max. Negotiated Rate |
$6,510.14 |
| Rate for Payer: Aetna Commercial |
$5,221.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,289.49
|
| Rate for Payer: Cash Price |
$3,390.70
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: First Health Commercial |
$6,442.33
|
| Rate for Payer: Humana Commercial |
$5,764.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,560.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,004.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,034.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,967.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,086.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,425.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,899.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,679.17
|
| Rate for Payer: PHCS Commercial |
$6,510.14
|
| Rate for Payer: United Healthcare All Payer |
$5,967.63
|
|
|
TRIDENT INSERT 10^ 32MM CODE I
|
Facility
|
OP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem Medicaid |
$2,949.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Humana KY Medicaid |
$2,949.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE I
|
Facility
|
IP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE J
|
Facility
|
IP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 32MM CODE J
|
Facility
|
OP
|
$8,577.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.16 |
| Max. Negotiated Rate |
$8,234.11 |
| Rate for Payer: Aetna Commercial |
$6,604.44
|
| Rate for Payer: Anthem Medicaid |
$2,949.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.22
|
| Rate for Payer: Cash Price |
$4,288.60
|
| Rate for Payer: Cigna Commercial |
$7,119.08
|
| Rate for Payer: First Health Commercial |
$8,148.34
|
| Rate for Payer: Humana Commercial |
$7,290.62
|
| Rate for Payer: Humana KY Medicaid |
$2,949.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,462.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,918.27
|
| Rate for Payer: PHCS Commercial |
$8,234.11
|
| Rate for Payer: United Healthcare All Payer |
$7,547.94
|
|
|
TRIDENT INSERT 10^ 36MM CODE F
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT INSERT 10^ 36MM CODE F
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT INSERT 10^ 36MM CODE H
|
Facility
|
IP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
TRIDENT INSERT 10^ 36MM CODE H
|
Facility
|
OP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem Medicaid |
$2,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Humana KY Medicaid |
$2,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,660.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,686.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
TRIDENT INSRT 10^ 36MM CODE D
|
Facility
|
OP
|
$9,376.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,812.97 |
| Max. Negotiated Rate |
$9,001.49 |
| Rate for Payer: Aetna Commercial |
$7,219.94
|
| Rate for Payer: Anthem Medicaid |
$3,224.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,313.71
|
| Rate for Payer: Cash Price |
$4,688.27
|
| Rate for Payer: Cigna Commercial |
$7,782.54
|
| Rate for Payer: First Health Commercial |
$8,907.72
|
| Rate for Payer: Humana Commercial |
$7,970.07
|
| Rate for Payer: Humana KY Medicaid |
$3,224.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,257.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,688.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,919.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,812.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,289.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,251.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,032.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,501.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,157.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,469.82
|
| Rate for Payer: PHCS Commercial |
$9,001.49
|
| Rate for Payer: United Healthcare All Payer |
$8,251.36
|
|
|
TRIDENT INSRT 10^ 36MM CODE D
|
Facility
|
IP
|
$9,376.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,812.97 |
| Max. Negotiated Rate |
$9,001.49 |
| Rate for Payer: Aetna Commercial |
$7,219.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,313.71
|
| Rate for Payer: Cash Price |
$4,688.27
|
| Rate for Payer: Cigna Commercial |
$7,782.54
|
| Rate for Payer: First Health Commercial |
$8,907.72
|
| Rate for Payer: Humana Commercial |
$7,970.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,688.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,919.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,812.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,251.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,032.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,501.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,157.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,469.82
|
| Rate for Payer: PHCS Commercial |
$9,001.49
|
| Rate for Payer: United Healthcare All Payer |
$8,251.36
|
|
|
TRIDENT INSRT 10^ 36MM CODE E
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT INSRT 10^ 36MM CODE E
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT INSRT 10^ 36MM CODE G
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT INSRT 10^ 36MM CODE G
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
