|
TRIDENT INSRT 10^ 36MM CODE I
|
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 I
|
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 INSRT 10^ 36MM CODE J
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT INSRT 10^ 36MM CODE J
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIDENT PATELLA 29X9X3
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT PATELLA 29X9X3
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT PATELLA A29X9X3
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A29X9X3
|
Facility
|
OP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem Medicaid |
$1,683.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Humana KY Medicaid |
$1,683.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A32X10X3
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT PATELLA A32X10X3
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT PATELLA A35X10X3
|
Facility
|
OP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem Medicaid |
$1,683.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Humana KY Medicaid |
$1,683.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A35X10X3
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A38X11X3
|
Facility
|
OP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem Medicaid |
$1,683.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Humana KY Medicaid |
$1,683.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A38X11X3
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIDENT PATELLA A40X11X3
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT PATELLA A40X11X3
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIDENT X3 10*POLY INSERT 36G
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT X3 10*POLY INSERT 36G
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT X3 28MM ELE RIM C
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM C
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM D
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM D
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM E
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM E
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
TRIDENT X3 28MM ELE RIM F
|
Facility
|
IP
|
$9,114.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.34 |
| Max. Negotiated Rate |
$8,749.90 |
| Rate for Payer: Aetna Commercial |
$7,018.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,109.29
|
| Rate for Payer: Cash Price |
$4,557.24
|
| Rate for Payer: Cigna Commercial |
$7,565.02
|
| Rate for Payer: First Health Commercial |
$8,658.76
|
| Rate for Payer: Humana Commercial |
$7,747.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,726.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,929.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.99
|
| Rate for Payer: PHCS Commercial |
$8,749.90
|
| Rate for Payer: United Healthcare All Payer |
$8,020.74
|
|
