|
TRIDENT X3 28MM ELE RIM E
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
TRIDENT X3 28MM ELE RIM F
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM F
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM G
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM G
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM H
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM H
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM I
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM I
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM J
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 28MM ELE RIM J
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM E
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM E
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM F
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM F
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM G
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM G
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM H
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM H
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM I
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM I
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM J
|
Facility
|
IP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 32MM ELE RIM J
|
Facility
|
OP
|
$8,914.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.88 |
| Max. Negotiated Rate |
$8,557.90 |
| Rate for Payer: Aetna Commercial |
$6,864.15
|
| Rate for Payer: Anthem Medicaid |
$3,065.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.29
|
| Rate for Payer: Cash Price |
$4,457.24
|
| Rate for Payer: Cigna Commercial |
$7,399.02
|
| Rate for Payer: First Health Commercial |
$8,468.76
|
| Rate for Payer: Humana Commercial |
$7,577.31
|
| Rate for Payer: Humana KY Medicaid |
$3,065.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.49
|
| Rate for Payer: PHCS Commercial |
$8,557.90
|
| Rate for Payer: United Healthcare All Payer |
$7,844.74
|
|
|
TRIDENT X3 36MM ELE RIM E
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM E
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
