|
TRIATHLON CR FEM COMP #4 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 #4 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 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 #5 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 #5 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 #5 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 #5 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 #6 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 #6 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 #6 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 #6 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 #7 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 #7 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 #7 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 #7 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 #8 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 #8 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 #8 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 #8 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 BEAD 1L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRIATHLON CR FEM COMP BEAD 1L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRIATHLON CR FEM COMP BEAD 1R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRIATHLON CR FEM COMP BEAD 1R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRIATHLON CR FEM COMP BEAD 2L
|
Facility
|
IP
|
$14,044.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,825.74 |
| Max. Negotiated Rate |
$13,482.37 |
| Rate for Payer: Aetna Commercial |
$10,813.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,954.43
|
| Rate for Payer: Cash Price |
$7,022.07
|
| Rate for Payer: Cigna Commercial |
$11,656.64
|
| Rate for Payer: First Health Commercial |
$13,341.93
|
| Rate for Payer: Humana Commercial |
$11,937.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,516.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,364.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,358.84
|
| Rate for Payer: Ohio Health Group HMO |
$10,533.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,808.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,353.68
|
| Rate for Payer: PHCS Commercial |
$13,482.37
|
| Rate for Payer: United Healthcare All Payer |
$12,358.84
|
|
|
TRIATHLON CR FEM COMP BEAD 2L
|
Facility
|
OP
|
$14,044.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,825.74 |
| Max. Negotiated Rate |
$13,482.37 |
| Rate for Payer: Aetna Commercial |
$10,813.99
|
| Rate for Payer: Anthem Medicaid |
$4,829.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,954.43
|
| Rate for Payer: Cash Price |
$7,022.07
|
| Rate for Payer: Cigna Commercial |
$11,656.64
|
| Rate for Payer: First Health Commercial |
$13,341.93
|
| Rate for Payer: Humana Commercial |
$11,937.52
|
| Rate for Payer: Humana KY Medicaid |
$4,829.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,878.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,516.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,364.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,213.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,926.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,358.84
|
| Rate for Payer: Ohio Health Group HMO |
$10,533.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,808.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,353.68
|
| Rate for Payer: PHCS Commercial |
$13,482.37
|
| Rate for Payer: United Healthcare All Payer |
$12,358.84
|
|
