|
TRIDENT CROSSFIRE 10^ 28H
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 28I
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 28I
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 28J
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 28J
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32D
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32D
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32E
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32E
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32F
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32F
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32G
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32G
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32H
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32H
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32I
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32I
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32J
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CROSSFIRE 10^ 32J
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
TRIDENT CUP PSL 46MM
|
Facility
|
IP
|
$9,675.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,902.54 |
| Max. Negotiated Rate |
$9,288.12 |
| Rate for Payer: Aetna Commercial |
$7,449.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,546.59
|
| Rate for Payer: Cash Price |
$4,837.56
|
| Rate for Payer: Cigna Commercial |
$8,030.35
|
| Rate for Payer: First Health Commercial |
$9,191.36
|
| Rate for Payer: Humana Commercial |
$8,223.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,933.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,140.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,514.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,256.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,740.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,417.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,675.83
|
| Rate for Payer: PHCS Commercial |
$9,288.12
|
| Rate for Payer: United Healthcare All Payer |
$8,514.11
|
|
|
TRIDENT CUP PSL 46MM
|
Facility
|
OP
|
$9,675.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,902.54 |
| Max. Negotiated Rate |
$9,288.12 |
| Rate for Payer: Aetna Commercial |
$7,449.84
|
| Rate for Payer: Anthem Medicaid |
$3,327.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,546.59
|
| Rate for Payer: Cash Price |
$4,837.56
|
| Rate for Payer: Cigna Commercial |
$8,030.35
|
| Rate for Payer: First Health Commercial |
$9,191.36
|
| Rate for Payer: Humana Commercial |
$8,223.85
|
| Rate for Payer: Humana KY Medicaid |
$3,327.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,361.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,933.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,140.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,394.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,514.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,256.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,740.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,417.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,675.83
|
| Rate for Payer: PHCS Commercial |
$9,288.12
|
| Rate for Payer: United Healthcare All Payer |
$8,514.11
|
|
|
TRIDENT CUP PSL 48MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT CUP PSL 48MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT CUP PSL 50MM
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
TRIDENT CUP PSL 50MM
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
