|
TRIATHLON CR FEM COMP BEAD 2R
|
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 2R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 3L
|
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 3L
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 3R
|
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 3R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 4L
|
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 4L
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 4R
|
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 4R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 5L
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 5L
|
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 5R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 5R
|
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 6L
|
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 6L
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 6R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 6R
|
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 7L
|
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 7L
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 7R
|
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 7R
|
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
|
|
|
TRIATHLON CR FEM COMP BEAD 8L
|
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 8L
|
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 8R
|
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
|
|
