|
TRIDENT CROSSFIRE 0^ 28I
|
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^ 28I
|
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^ 28J
|
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^ 28J
|
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^ 32D
|
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^ 32D
|
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^ 32E
|
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^ 32E
|
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^ 32F
|
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^ 32F
|
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^ 32G
|
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^ 32G
|
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^ 32H
|
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^ 32H
|
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^ 32I
|
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^ 32I
|
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^ 32J
|
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^ 32J
|
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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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 10^ 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
|
|
