|
TRIATHLN TS+ TIB INSRT #8 31MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #8 31MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLON ASYM PAT A29M*9M
|
Facility
|
IP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A29M*9M
|
Facility
|
OP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem Medicaid |
$1,741.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Humana KY Medicaid |
$1,741.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,759.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,776.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A32M*10M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON ASYM PAT A32M*10M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON ASYM PAT A35M*10M
|
Facility
|
OP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem Medicaid |
$1,741.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Humana KY Medicaid |
$1,741.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,759.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,776.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A35M*10M
|
Facility
|
IP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A38M*11M
|
Facility
|
IP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A38M*11M
|
Facility
|
OP
|
$5,064.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$4,861.82 |
| Rate for Payer: Aetna Commercial |
$3,899.59
|
| Rate for Payer: Anthem Medicaid |
$1,741.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,950.23
|
| Rate for Payer: Cash Price |
$2,532.20
|
| Rate for Payer: Cigna Commercial |
$4,203.45
|
| Rate for Payer: First Health Commercial |
$4,811.18
|
| Rate for Payer: Humana Commercial |
$4,304.74
|
| Rate for Payer: Humana KY Medicaid |
$1,741.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,759.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,152.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,737.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,776.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,456.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,798.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,569.96
|
| Rate for Payer: PHCS Commercial |
$4,861.82
|
| Rate for Payer: United Healthcare All Payer |
$4,456.67
|
|
|
TRIATHLON ASYM PAT A40M*11M
|
Facility
|
OP
|
$4,916.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.08 |
| Max. Negotiated Rate |
$4,719.36 |
| Rate for Payer: Aetna Commercial |
$3,785.32
|
| Rate for Payer: Anthem Medicaid |
$1,690.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,834.48
|
| Rate for Payer: Cash Price |
$2,458.00
|
| Rate for Payer: Cigna Commercial |
$4,080.28
|
| Rate for Payer: First Health Commercial |
$4,670.20
|
| Rate for Payer: Humana Commercial |
$4,178.60
|
| Rate for Payer: Humana KY Medicaid |
$1,690.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,707.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,031.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,628.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,724.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,326.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,687.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.96
|
| Rate for Payer: PHCS Commercial |
$4,719.36
|
| Rate for Payer: United Healthcare All Payer |
$4,326.08
|
|
|
TRIATHLON ASYM PAT A40M*11M
|
Facility
|
IP
|
$4,916.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.08 |
| Max. Negotiated Rate |
$4,719.36 |
| Rate for Payer: Aetna Commercial |
$3,785.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,834.48
|
| Rate for Payer: Cash Price |
$2,458.00
|
| Rate for Payer: Cigna Commercial |
$4,080.28
|
| Rate for Payer: First Health Commercial |
$4,670.20
|
| Rate for Payer: Humana Commercial |
$4,178.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,031.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,628.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,326.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,687.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.96
|
| Rate for Payer: PHCS Commercial |
$4,719.36
|
| Rate for Payer: United Healthcare All Payer |
$4,326.08
|
|
|
TRIATHLON CR FEM COMP #1 LT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON CR FEM COMP #1 LT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON CR FEM COMP #1 RT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON CR FEM COMP #1 RT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON CR FEM COMP #2 LT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #2 LT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #2 RT
|
Facility
|
OP
|
$11,192.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.07 |
| Max. Negotiated Rate |
$10,745.12 |
| Rate for Payer: Aetna Commercial |
$8,618.48
|
| Rate for Payer: Anthem Medicaid |
$3,849.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.41
|
| Rate for Payer: Cash Price |
$5,596.42
|
| Rate for Payer: Cigna Commercial |
$9,290.05
|
| Rate for Payer: First Health Commercial |
$10,633.19
|
| Rate for Payer: Humana Commercial |
$9,513.91
|
| Rate for Payer: Humana KY Medicaid |
$3,849.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,469.78
|
| Rate for Payer: PHCS Commercial |
$10,745.12
|
| Rate for Payer: United Healthcare All Payer |
$9,849.69
|
|
|
TRIATHLON CR FEM COMP #2 RT
|
Facility
|
IP
|
$11,192.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.07 |
| Max. Negotiated Rate |
$10,745.12 |
| Rate for Payer: Aetna Commercial |
$8,618.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.41
|
| Rate for Payer: Cash Price |
$5,596.42
|
| Rate for Payer: Cigna Commercial |
$9,290.05
|
| Rate for Payer: First Health Commercial |
$10,633.19
|
| Rate for Payer: Humana Commercial |
$9,513.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,469.78
|
| Rate for Payer: PHCS Commercial |
$10,745.12
|
| Rate for Payer: United Healthcare All Payer |
$9,849.69
|
|
|
TRIATHLON CR FEM COMP #3 LT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #3 LT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #3 RT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #3 RT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON CR FEM COMP #4 LT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
