|
TRIDENT X3 28MM ELE RIM F
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 28MM ELE RIM G
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 28MM ELE RIM G
|
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
|
|
|
TRIDENT X3 28MM ELE RIM H
|
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
|
|
|
TRIDENT X3 28MM ELE RIM H
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 28MM ELE RIM I
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 28MM ELE RIM I
|
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
|
|
|
TRIDENT X3 28MM ELE RIM J
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 28MM ELE RIM J
|
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
|
|
|
TRIDENT X3 32MM ELE RIM E
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 32MM ELE RIM E
|
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
|
|
|
TRIDENT X3 32MM 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
|
|
|
TRIDENT X3 32MM ELE RIM F
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 32MM ELE RIM G
|
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
|
|
|
TRIDENT X3 32MM ELE RIM G
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 32MM ELE RIM H
|
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
|
|
|
TRIDENT X3 32MM ELE RIM H
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 32MM ELE RIM I
|
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
|
|
|
TRIDENT X3 32MM ELE RIM I
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 32MM ELE RIM J
|
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
|
|
|
TRIDENT X3 32MM ELE RIM J
|
Facility
|
OP
|
$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 Medicaid |
$3,134.47
|
| 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: Humana KY Medicaid |
$3,134.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.37
|
| 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: Molina Healthcare Medicaid |
$3,197.36
|
| 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
|
|
|
TRIDENT X3 36MM ELE RIM E
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM E
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM F
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM F
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
