|
TRIDENT 10 X3 INSERT 36MM E
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIDENT 10 X3 INSERT 36MM F
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIDENT 10 X3 INSERT 36MM F
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIDENT 10 X3 INSERT 36MM G
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIDENT 10 X3 INSERT 36MM G
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIDENT 10 X3 INSERT 36MM H
|
Facility
|
IP
|
$7,733.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.30 |
| Max. Negotiated Rate |
$7,423.73 |
| Rate for Payer: Aetna Commercial |
$5,954.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.78
|
| Rate for Payer: Cash Price |
$3,866.52
|
| Rate for Payer: Cigna Commercial |
$6,418.43
|
| Rate for Payer: First Health Commercial |
$7,346.40
|
| Rate for Payer: Humana Commercial |
$6,573.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.25
|
| Rate for Payer: PHCS Commercial |
$7,423.73
|
| Rate for Payer: United Healthcare All Payer |
$6,805.08
|
|
|
TRIDENT 10 X3 INSERT 36MM H
|
Facility
|
OP
|
$7,733.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.30 |
| Max. Negotiated Rate |
$7,423.73 |
| Rate for Payer: Aetna Commercial |
$5,954.45
|
| Rate for Payer: Anthem Medicaid |
$2,659.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.78
|
| Rate for Payer: Cash Price |
$3,866.52
|
| Rate for Payer: Cigna Commercial |
$6,418.43
|
| Rate for Payer: First Health Commercial |
$7,346.40
|
| Rate for Payer: Humana Commercial |
$6,573.09
|
| Rate for Payer: Humana KY Medicaid |
$2,659.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,686.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.25
|
| Rate for Payer: PHCS Commercial |
$7,423.73
|
| Rate for Payer: United Healthcare All Payer |
$6,805.08
|
|
|
TRIDENT 10 X3 INSERT 36MM I
|
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 10 X3 INSERT 36MM I
|
Facility
|
OP
|
$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 Medicaid |
$3,197.24
|
| 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: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| 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: Molina Healthcare Medicaid |
$3,261.39
|
| 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 10 X3 INSERT 36MM J
|
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 10 X3 INSERT 36MM J
|
Facility
|
OP
|
$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 Medicaid |
$3,197.24
|
| 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: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| 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: Molina Healthcare Medicaid |
$3,261.39
|
| 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 CROSSFIRE 0^ 28B
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28B
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28C
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28C
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28D
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28D
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28E
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28E
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28F
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28F
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28G
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28G
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28H
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
TRIDENT CROSSFIRE 0^ 28H
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
