|
TRIATHLON PATELLA S33X9X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIATHLON PATELLA S33X9X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIATHLON PATELLA S36X10X3
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLON PATELLA S36X10X3
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLON PATELLA S39X11X3
|
Facility
|
OP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem Medicaid |
$1,695.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Humana KY Medicaid |
$1,695.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,713.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
TRIATHLON PATELLA S39X11X3
|
Facility
|
IP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
TRIATHLON POST AUG SZ 1 10MM
|
Facility
|
IP
|
$7,760.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.85 |
| Max. Negotiated Rate |
$7,449.94 |
| Rate for Payer: Aetna Commercial |
$5,975.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,053.07
|
| Rate for Payer: Cash Price |
$3,880.18
|
| Rate for Payer: Cigna Commercial |
$6,441.09
|
| Rate for Payer: First Health Commercial |
$7,372.33
|
| Rate for Payer: Humana Commercial |
$6,596.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,363.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,727.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,829.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,820.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.71
|
| Rate for Payer: PHCS Commercial |
$7,449.94
|
| Rate for Payer: United Healthcare All Payer |
$6,829.11
|
|
|
TRIATHLON POST AUG SZ 1 10MM
|
Facility
|
OP
|
$7,760.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.85 |
| Max. Negotiated Rate |
$7,449.94 |
| Rate for Payer: Aetna Commercial |
$5,975.47
|
| Rate for Payer: Anthem Medicaid |
$2,668.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,053.07
|
| Rate for Payer: Cash Price |
$3,880.18
|
| Rate for Payer: Cigna Commercial |
$6,441.09
|
| Rate for Payer: First Health Commercial |
$7,372.33
|
| Rate for Payer: Humana Commercial |
$6,596.30
|
| Rate for Payer: Humana KY Medicaid |
$2,668.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,695.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,363.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,727.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,722.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,829.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,820.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.71
|
| Rate for Payer: PHCS Commercial |
$7,449.94
|
| Rate for Payer: United Healthcare All Payer |
$6,829.11
|
|
|
TRIATHLON POST AUG SZ 1 5MM
|
Facility
|
OP
|
$7,570.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.12 |
| Max. Negotiated Rate |
$7,267.38 |
| Rate for Payer: Aetna Commercial |
$5,829.05
|
| Rate for Payer: Anthem Medicaid |
$2,603.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,904.75
|
| Rate for Payer: Cash Price |
$3,785.09
|
| Rate for Payer: Cigna Commercial |
$6,283.26
|
| Rate for Payer: First Health Commercial |
$7,191.68
|
| Rate for Payer: Humana Commercial |
$6,434.66
|
| Rate for Payer: Humana KY Medicaid |
$2,603.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,629.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,207.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,586.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,655.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,661.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,677.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.76
|
| Rate for Payer: PHCS Commercial |
$7,267.38
|
| Rate for Payer: United Healthcare All Payer |
$6,661.77
|
|
|
TRIATHLON POST AUG SZ 1 5MM
|
Facility
|
IP
|
$7,570.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.12 |
| Max. Negotiated Rate |
$7,267.38 |
| Rate for Payer: Aetna Commercial |
$5,829.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,904.75
|
| Rate for Payer: Cash Price |
$3,785.09
|
| Rate for Payer: Cigna Commercial |
$6,283.26
|
| Rate for Payer: First Health Commercial |
$7,191.68
|
| Rate for Payer: Humana Commercial |
$6,434.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,207.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,586.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,661.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,677.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.76
|
| Rate for Payer: PHCS Commercial |
$7,267.38
|
| Rate for Payer: United Healthcare All Payer |
$6,661.77
|
|
|
TRIATHLON POST AUG SZ 2 10MM
|
Facility
|
IP
|
$7,760.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.85 |
| Max. Negotiated Rate |
$7,449.94 |
| Rate for Payer: Aetna Commercial |
$5,975.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,053.07
|
| Rate for Payer: Cash Price |
$3,880.18
|
| Rate for Payer: Cigna Commercial |
$6,441.09
|
| Rate for Payer: First Health Commercial |
$7,372.33
|
| Rate for Payer: Humana Commercial |
$6,596.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,363.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,727.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,829.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,820.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.71
|
| Rate for Payer: PHCS Commercial |
$7,449.94
|
| Rate for Payer: United Healthcare All Payer |
$6,829.11
|
|
|
TRIATHLON POST AUG SZ 2 10MM
|
Facility
|
OP
|
$7,760.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.85 |
| Max. Negotiated Rate |
$7,449.94 |
| Rate for Payer: Aetna Commercial |
$5,975.47
|
| Rate for Payer: Anthem Medicaid |
$2,668.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,053.07
|
| Rate for Payer: Cash Price |
$3,880.18
|
| Rate for Payer: Cigna Commercial |
$6,441.09
|
| Rate for Payer: First Health Commercial |
$7,372.33
|
| Rate for Payer: Humana Commercial |
$6,596.30
|
| Rate for Payer: Humana KY Medicaid |
$2,668.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,695.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,363.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,727.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,722.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,829.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,820.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,405.71
|
| Rate for Payer: PHCS Commercial |
$7,449.94
|
| Rate for Payer: United Healthcare All Payer |
$6,829.11
|
|
|
TRIATHLON POST AUG SZ 2 5MM
|
Facility
|
OP
|
$7,570.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.12 |
| Max. Negotiated Rate |
$7,267.38 |
| Rate for Payer: Aetna Commercial |
$5,829.05
|
| Rate for Payer: Anthem Medicaid |
$2,603.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,904.75
|
| Rate for Payer: Cash Price |
$3,785.09
|
| Rate for Payer: Cigna Commercial |
$6,283.26
|
| Rate for Payer: First Health Commercial |
$7,191.68
|
| Rate for Payer: Humana Commercial |
$6,434.66
|
| Rate for Payer: Humana KY Medicaid |
$2,603.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,629.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,207.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,586.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,655.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,661.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,677.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.76
|
| Rate for Payer: PHCS Commercial |
$7,267.38
|
| Rate for Payer: United Healthcare All Payer |
$6,661.77
|
|
|
TRIATHLON POST AUG SZ 2 5MM
|
Facility
|
IP
|
$7,570.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.12 |
| Max. Negotiated Rate |
$7,267.38 |
| Rate for Payer: Aetna Commercial |
$5,829.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,904.75
|
| Rate for Payer: Cash Price |
$3,785.09
|
| Rate for Payer: Cigna Commercial |
$6,283.26
|
| Rate for Payer: First Health Commercial |
$7,191.68
|
| Rate for Payer: Humana Commercial |
$6,434.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,207.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,586.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,661.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,677.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.76
|
| Rate for Payer: PHCS Commercial |
$7,267.38
|
| Rate for Payer: United Healthcare All Payer |
$6,661.77
|
|
|
TRIATHLON POST AUG SZ 3 10MM
|
Facility
|
OP
|
$7,761.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.04 |
| Max. Negotiated Rate |
$7,451.34 |
| Rate for Payer: Aetna Commercial |
$5,976.59
|
| Rate for Payer: Anthem Medicaid |
$2,669.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.21
|
| Rate for Payer: Cash Price |
$3,880.91
|
| Rate for Payer: Cigna Commercial |
$6,442.30
|
| Rate for Payer: First Health Commercial |
$7,373.72
|
| Rate for Payer: Humana Commercial |
$6,597.54
|
| Rate for Payer: Humana KY Medicaid |
$2,669.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,364.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,722.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.16
|
| Rate for Payer: PHCS Commercial |
$7,451.34
|
| Rate for Payer: United Healthcare All Payer |
$6,830.39
|
|
|
TRIATHLON POST AUG SZ 3 10MM
|
Facility
|
IP
|
$7,761.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.04 |
| Max. Negotiated Rate |
$7,451.34 |
| Rate for Payer: Aetna Commercial |
$5,976.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.21
|
| Rate for Payer: Cash Price |
$3,880.91
|
| Rate for Payer: Cigna Commercial |
$6,442.30
|
| Rate for Payer: First Health Commercial |
$7,373.72
|
| Rate for Payer: Humana Commercial |
$6,597.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,364.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.16
|
| Rate for Payer: PHCS Commercial |
$7,451.34
|
| Rate for Payer: United Healthcare All Payer |
$6,830.39
|
|
|
TRIATHLON POST AUG SZ 3 5MM
|
Facility
|
IP
|
$7,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.86 |
| Max. Negotiated Rate |
$7,125.12 |
| Rate for Payer: Aetna Commercial |
$5,714.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.16
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$6,160.26
|
| Rate for Payer: First Health Commercial |
$7,050.90
|
| Rate for Payer: Humana Commercial |
$6,308.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,300.82
|
| Rate for Payer: PHCS Commercial |
$7,125.12
|
| Rate for Payer: United Healthcare All Payer |
$6,531.36
|
|
|
TRIATHLON POST AUG SZ 3 5MM
|
Facility
|
OP
|
$7,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.86 |
| Max. Negotiated Rate |
$7,125.12 |
| Rate for Payer: Aetna Commercial |
$5,714.94
|
| Rate for Payer: Anthem Medicaid |
$2,552.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.16
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$6,160.26
|
| Rate for Payer: First Health Commercial |
$7,050.90
|
| Rate for Payer: Humana Commercial |
$6,308.70
|
| Rate for Payer: Humana KY Medicaid |
$2,552.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,578.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,603.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,300.82
|
| Rate for Payer: PHCS Commercial |
$7,125.12
|
| Rate for Payer: United Healthcare All Payer |
$6,531.36
|
|
|
TRIATHLON POST AUG SZ 4 10MM
|
Facility
|
OP
|
$7,180.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.41 |
| Max. Negotiated Rate |
$6,892.91 |
| Rate for Payer: Aetna Commercial |
$5,528.68
|
| Rate for Payer: Anthem Medicaid |
$2,469.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.49
|
| Rate for Payer: Cash Price |
$3,590.05
|
| Rate for Payer: Cigna Commercial |
$5,959.49
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: Humana Commercial |
$6,103.09
|
| Rate for Payer: Humana KY Medicaid |
$2,469.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.83
|
| Rate for Payer: PHCS Commercial |
$6,892.91
|
| Rate for Payer: United Healthcare All Payer |
$6,318.50
|
|
|
TRIATHLON POST AUG SZ 4 10MM
|
Facility
|
IP
|
$7,180.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.41 |
| Max. Negotiated Rate |
$6,892.91 |
| Rate for Payer: Aetna Commercial |
$5,528.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.49
|
| Rate for Payer: Cash Price |
$3,590.05
|
| Rate for Payer: Cigna Commercial |
$5,959.49
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: Humana Commercial |
$6,103.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.83
|
| Rate for Payer: PHCS Commercial |
$6,892.91
|
| Rate for Payer: United Healthcare All Payer |
$6,318.50
|
|
|
TRIATHLON POST AUG SZ 4 5MM
|
Facility
|
IP
|
$7,445.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.94 |
| Max. Negotiated Rate |
$7,147.89 |
| Rate for Payer: Aetna Commercial |
$5,733.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,807.66
|
| Rate for Payer: Cash Price |
$3,722.86
|
| Rate for Payer: Cigna Commercial |
$6,179.95
|
| Rate for Payer: First Health Commercial |
$7,073.43
|
| Rate for Payer: Humana Commercial |
$6,328.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,105.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,552.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.17
|
| Rate for Payer: PHCS Commercial |
$7,147.89
|
| Rate for Payer: United Healthcare All Payer |
$6,552.23
|
|
|
TRIATHLON POST AUG SZ 4 5MM
|
Facility
|
OP
|
$7,445.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.94 |
| Max. Negotiated Rate |
$7,147.89 |
| Rate for Payer: Aetna Commercial |
$5,733.20
|
| Rate for Payer: Anthem Medicaid |
$2,560.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,807.66
|
| Rate for Payer: Cash Price |
$3,722.86
|
| Rate for Payer: Cigna Commercial |
$6,179.95
|
| Rate for Payer: First Health Commercial |
$7,073.43
|
| Rate for Payer: Humana Commercial |
$6,328.86
|
| Rate for Payer: Humana KY Medicaid |
$2,560.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,105.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,611.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,552.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.17
|
| Rate for Payer: PHCS Commercial |
$7,147.89
|
| Rate for Payer: United Healthcare All Payer |
$6,552.23
|
|
|
TRIATHLON POST AUG SZ 5 10MM
|
Facility
|
IP
|
$7,180.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.41 |
| Max. Negotiated Rate |
$6,892.91 |
| Rate for Payer: Aetna Commercial |
$5,528.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.49
|
| Rate for Payer: Cash Price |
$3,590.05
|
| Rate for Payer: Cigna Commercial |
$5,959.49
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: Humana Commercial |
$6,103.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.83
|
| Rate for Payer: PHCS Commercial |
$6,892.91
|
| Rate for Payer: United Healthcare All Payer |
$6,318.50
|
|
|
TRIATHLON POST AUG SZ 5 10MM
|
Facility
|
OP
|
$7,180.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.41 |
| Max. Negotiated Rate |
$6,892.91 |
| Rate for Payer: Aetna Commercial |
$5,528.68
|
| Rate for Payer: Anthem Medicaid |
$2,469.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.49
|
| Rate for Payer: Cash Price |
$3,590.05
|
| Rate for Payer: Cigna Commercial |
$5,959.49
|
| Rate for Payer: First Health Commercial |
$6,821.10
|
| Rate for Payer: Humana Commercial |
$6,103.09
|
| Rate for Payer: Humana KY Medicaid |
$2,469.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.83
|
| Rate for Payer: PHCS Commercial |
$6,892.91
|
| Rate for Payer: United Healthcare All Payer |
$6,318.50
|
|
|
TRIATHLON POST AUG SZ 5 5MM
|
Facility
|
OP
|
$8,285.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$7,954.16 |
| Rate for Payer: Aetna Commercial |
$6,379.90
|
| Rate for Payer: Anthem Medicaid |
$2,849.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.75
|
| Rate for Payer: Cash Price |
$4,142.79
|
| Rate for Payer: Cigna Commercial |
$6,877.03
|
| Rate for Payer: First Health Commercial |
$7,871.30
|
| Rate for Payer: Humana Commercial |
$7,042.74
|
| Rate for Payer: Humana KY Medicaid |
$2,849.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,794.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,291.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,214.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.53
|
| Rate for Payer: PHCS Commercial |
$7,954.16
|
| Rate for Payer: United Healthcare All Payer |
$7,291.31
|
|
