|
TRIDENT CUP PSL 52MM
|
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 52MM
|
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 54MM
|
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 54MM
|
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 56MM
|
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 56MM
|
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 58MM
|
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 58MM
|
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 60MM
|
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 60MM
|
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 62MM
|
Facility
|
OP
|
$9,479.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,843.84 |
| Max. Negotiated Rate |
$9,100.30 |
| Rate for Payer: Aetna Commercial |
$7,299.20
|
| Rate for Payer: Anthem Medicaid |
$3,259.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.99
|
| Rate for Payer: Cash Price |
$4,739.74
|
| Rate for Payer: Cigna Commercial |
$7,867.97
|
| Rate for Payer: First Health Commercial |
$9,005.51
|
| Rate for Payer: Humana Commercial |
$8,057.56
|
| Rate for Payer: Humana KY Medicaid |
$3,259.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,293.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,247.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,540.84
|
| Rate for Payer: PHCS Commercial |
$9,100.30
|
| Rate for Payer: United Healthcare All Payer |
$8,341.94
|
|
|
TRIDENT CUP PSL 62MM
|
Facility
|
IP
|
$9,479.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,843.84 |
| Max. Negotiated Rate |
$9,100.30 |
| Rate for Payer: Aetna Commercial |
$7,299.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.99
|
| Rate for Payer: Cash Price |
$4,739.74
|
| Rate for Payer: Cigna Commercial |
$7,867.97
|
| Rate for Payer: First Health Commercial |
$9,005.51
|
| Rate for Payer: Humana Commercial |
$8,057.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,247.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,540.84
|
| Rate for Payer: PHCS Commercial |
$9,100.30
|
| Rate for Payer: United Healthcare All Payer |
$8,341.94
|
|
|
TRIDENT CUP PSL 64MM
|
Facility
|
OP
|
$9,479.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,843.84 |
| Max. Negotiated Rate |
$9,100.30 |
| Rate for Payer: Aetna Commercial |
$7,299.20
|
| Rate for Payer: Anthem Medicaid |
$3,259.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.99
|
| Rate for Payer: Cash Price |
$4,739.74
|
| Rate for Payer: Cigna Commercial |
$7,867.97
|
| Rate for Payer: First Health Commercial |
$9,005.51
|
| Rate for Payer: Humana Commercial |
$8,057.56
|
| Rate for Payer: Humana KY Medicaid |
$3,259.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,293.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,247.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,540.84
|
| Rate for Payer: PHCS Commercial |
$9,100.30
|
| Rate for Payer: United Healthcare All Payer |
$8,341.94
|
|
|
TRIDENT CUP PSL 64MM
|
Facility
|
IP
|
$9,479.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,843.84 |
| Max. Negotiated Rate |
$9,100.30 |
| Rate for Payer: Aetna Commercial |
$7,299.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.99
|
| Rate for Payer: Cash Price |
$4,739.74
|
| Rate for Payer: Cigna Commercial |
$7,867.97
|
| Rate for Payer: First Health Commercial |
$9,005.51
|
| Rate for Payer: Humana Commercial |
$8,057.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,247.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,540.84
|
| Rate for Payer: PHCS Commercial |
$9,100.30
|
| Rate for Payer: United Healthcare All Payer |
$8,341.94
|
|
|
TRIDENT CUP PSL 66MM
|
Facility
|
IP
|
$8,533.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,560.02 |
| Max. Negotiated Rate |
$8,192.06 |
| Rate for Payer: Aetna Commercial |
$6,570.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,656.05
|
| Rate for Payer: Cash Price |
$4,266.70
|
| Rate for Payer: Cigna Commercial |
$7,082.72
|
| Rate for Payer: First Health Commercial |
$8,106.73
|
| Rate for Payer: Humana Commercial |
$7,253.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,400.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,424.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,888.05
|
| Rate for Payer: PHCS Commercial |
$8,192.06
|
| Rate for Payer: United Healthcare All Payer |
$7,509.39
|
|
|
TRIDENT CUP PSL 66MM
|
Facility
|
OP
|
$8,533.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,560.02 |
| Max. Negotiated Rate |
$8,192.06 |
| Rate for Payer: Aetna Commercial |
$6,570.72
|
| Rate for Payer: Anthem Medicaid |
$2,934.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,656.05
|
| Rate for Payer: Cash Price |
$4,266.70
|
| Rate for Payer: Cigna Commercial |
$7,082.72
|
| Rate for Payer: First Health Commercial |
$8,106.73
|
| Rate for Payer: Humana Commercial |
$7,253.39
|
| Rate for Payer: Humana KY Medicaid |
$2,934.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,964.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,993.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,400.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,424.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,888.05
|
| Rate for Payer: PHCS Commercial |
$8,192.06
|
| Rate for Payer: United Healthcare All Payer |
$7,509.39
|
|
|
TRIDENT CUP PSL 68MM
|
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 68MM
|
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 ELEV RIM INSERT 32MM E
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 32MM E
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM D
|
Facility
|
IP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM D
|
Facility
|
OP
|
$8,326.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.82 |
| Max. Negotiated Rate |
$7,993.04 |
| Rate for Payer: Aetna Commercial |
$6,411.08
|
| Rate for Payer: Anthem Medicaid |
$2,863.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,494.34
|
| Rate for Payer: Cash Price |
$4,163.04
|
| Rate for Payer: Cigna Commercial |
$6,910.65
|
| Rate for Payer: First Health Commercial |
$7,909.78
|
| Rate for Payer: Humana Commercial |
$7,077.17
|
| Rate for Payer: Humana KY Medicaid |
$2,863.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,827.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,920.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,326.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,244.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,660.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,243.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.00
|
| Rate for Payer: PHCS Commercial |
$7,993.04
|
| Rate for Payer: United Healthcare All Payer |
$7,326.95
|
|
|
TRIDENT ELEV RIM INSERT 36MM E
|
Facility
|
IP
|
$8,647.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.18 |
| Max. Negotiated Rate |
$8,301.39 |
| Rate for Payer: Aetna Commercial |
$6,658.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.88
|
| Rate for Payer: Cash Price |
$4,323.64
|
| Rate for Payer: Cigna Commercial |
$7,177.24
|
| Rate for Payer: First Health Commercial |
$8,214.92
|
| Rate for Payer: Humana Commercial |
$7,350.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,917.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.62
|
| Rate for Payer: PHCS Commercial |
$8,301.39
|
| Rate for Payer: United Healthcare All Payer |
$7,609.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM E
|
Facility
|
OP
|
$8,647.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.18 |
| Max. Negotiated Rate |
$8,301.39 |
| Rate for Payer: Aetna Commercial |
$6,658.41
|
| Rate for Payer: Anthem Medicaid |
$2,973.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.88
|
| Rate for Payer: Cash Price |
$4,323.64
|
| Rate for Payer: Cigna Commercial |
$7,177.24
|
| Rate for Payer: First Health Commercial |
$8,214.92
|
| Rate for Payer: Humana Commercial |
$7,350.19
|
| Rate for Payer: Humana KY Medicaid |
$2,973.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,917.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.62
|
| Rate for Payer: PHCS Commercial |
$8,301.39
|
| Rate for Payer: United Healthcare All Payer |
$7,609.61
|
|
|
TRIDENT ELEV RIM INSERT 36MM F
|
Facility
|
OP
|
$8,647.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.18 |
| Max. Negotiated Rate |
$8,301.39 |
| Rate for Payer: Aetna Commercial |
$6,658.41
|
| Rate for Payer: Anthem Medicaid |
$2,973.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.88
|
| Rate for Payer: Cash Price |
$4,323.64
|
| Rate for Payer: Cigna Commercial |
$7,177.24
|
| Rate for Payer: First Health Commercial |
$8,214.92
|
| Rate for Payer: Humana Commercial |
$7,350.19
|
| Rate for Payer: Humana KY Medicaid |
$2,973.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,917.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.62
|
| Rate for Payer: PHCS Commercial |
$8,301.39
|
| Rate for Payer: United Healthcare All Payer |
$7,609.61
|
|
