|
TRIDENT CUP PSL 48MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 48MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 50MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 50MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 52MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 52MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 54MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 54MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 56MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 56MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 58MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 58MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 60MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 60MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 62MM
|
Facility
|
OP
|
$9,279.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.33 |
| Max. Negotiated Rate |
$8,908.30 |
| Rate for Payer: Aetna Commercial |
$7,145.20
|
| Rate for Payer: Anthem Medicaid |
$3,191.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,237.99
|
| Rate for Payer: Cash Price |
$4,639.74
|
| Rate for Payer: Cigna Commercial |
$7,701.97
|
| Rate for Payer: First Health Commercial |
$8,815.51
|
| Rate for Payer: Humana Commercial |
$7,887.56
|
| Rate for Payer: Humana KY Medicaid |
$3,191.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,223.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,609.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,848.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,255.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,165.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,959.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.64
|
| Rate for Payer: PHCS Commercial |
$8,908.30
|
| Rate for Payer: United Healthcare All Payer |
$8,165.94
|
|
|
TRIDENT CUP PSL 62MM
|
Facility
|
IP
|
$9,279.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.33 |
| Max. Negotiated Rate |
$8,908.30 |
| Rate for Payer: Aetna Commercial |
$7,145.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,237.99
|
| Rate for Payer: Cash Price |
$4,639.74
|
| Rate for Payer: Cigna Commercial |
$7,701.97
|
| Rate for Payer: First Health Commercial |
$8,815.51
|
| Rate for Payer: Humana Commercial |
$7,887.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,609.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,848.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,165.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,959.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.64
|
| Rate for Payer: PHCS Commercial |
$8,908.30
|
| Rate for Payer: United Healthcare All Payer |
$8,165.94
|
|
|
TRIDENT CUP PSL 64MM
|
Facility
|
OP
|
$9,279.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.33 |
| Max. Negotiated Rate |
$8,908.30 |
| Rate for Payer: Aetna Commercial |
$7,145.20
|
| Rate for Payer: Anthem Medicaid |
$3,191.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,237.99
|
| Rate for Payer: Cash Price |
$4,639.74
|
| Rate for Payer: Cigna Commercial |
$7,701.97
|
| Rate for Payer: First Health Commercial |
$8,815.51
|
| Rate for Payer: Humana Commercial |
$7,887.56
|
| Rate for Payer: Humana KY Medicaid |
$3,191.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,223.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,609.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,848.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,255.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,165.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,959.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.64
|
| Rate for Payer: PHCS Commercial |
$8,908.30
|
| Rate for Payer: United Healthcare All Payer |
$8,165.94
|
|
|
TRIDENT CUP PSL 64MM
|
Facility
|
IP
|
$9,279.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.33 |
| Max. Negotiated Rate |
$8,908.30 |
| Rate for Payer: Aetna Commercial |
$7,145.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,237.99
|
| Rate for Payer: Cash Price |
$4,639.74
|
| Rate for Payer: Cigna Commercial |
$7,701.97
|
| Rate for Payer: First Health Commercial |
$8,815.51
|
| Rate for Payer: Humana Commercial |
$7,887.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,609.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,848.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,165.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,959.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.64
|
| Rate for Payer: PHCS Commercial |
$8,908.30
|
| Rate for Payer: United Healthcare All Payer |
$8,165.94
|
|
|
TRIDENT CUP PSL 66MM
|
Facility
|
IP
|
$8,333.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.34 |
| Max. Negotiated Rate |
$8,000.06 |
| Rate for Payer: Aetna Commercial |
$6,416.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,500.05
|
| Rate for Payer: Cash Price |
$4,166.70
|
| Rate for Payer: Cigna Commercial |
$6,916.72
|
| Rate for Payer: First Health Commercial |
$7,916.73
|
| Rate for Payer: Humana Commercial |
$7,083.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,833.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,500.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,333.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,250.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,583.35
|
| Rate for Payer: PHCS Commercial |
$8,000.06
|
| Rate for Payer: United Healthcare All Payer |
$7,333.39
|
|
|
TRIDENT CUP PSL 66MM
|
Facility
|
OP
|
$8,333.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.34 |
| Max. Negotiated Rate |
$8,000.06 |
| Rate for Payer: Aetna Commercial |
$6,416.72
|
| Rate for Payer: Anthem Medicaid |
$2,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,500.05
|
| Rate for Payer: Cash Price |
$4,166.70
|
| Rate for Payer: Cigna Commercial |
$6,916.72
|
| Rate for Payer: First Health Commercial |
$7,916.73
|
| Rate for Payer: Humana Commercial |
$7,083.39
|
| Rate for Payer: Humana KY Medicaid |
$2,865.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,895.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,833.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,500.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,923.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,333.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,250.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,583.35
|
| Rate for Payer: PHCS Commercial |
$8,000.06
|
| Rate for Payer: United Healthcare All Payer |
$7,333.39
|
|
|
TRIDENT CUP PSL 68MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT CUP PSL 68MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TRIDENT ELEV RIM INSERT 32MM E
|
Facility
|
OP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem Medicaid |
$2,794.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Humana KY Medicaid |
$2,794.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 32MM E
|
Facility
|
IP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM D
|
Facility
|
IP
|
$8,126.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.39 |
| Max. Negotiated Rate |
$7,801.04 |
| Rate for Payer: Aetna Commercial |
$6,257.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,338.34
|
| Rate for Payer: Cash Price |
$4,063.04
|
| Rate for Payer: Cigna Commercial |
$6,744.65
|
| Rate for Payer: First Health Commercial |
$7,719.78
|
| Rate for Payer: Humana Commercial |
$6,907.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,663.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,150.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,094.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.08
|
| Rate for Payer: PHCS Commercial |
$7,801.04
|
| Rate for Payer: United Healthcare All Payer |
$7,150.95
|
|
