|
TRIATHLON POST AUG SZ 5 5MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TRIATHLON POST AUG SZ 6 10MM
|
Facility
|
IP
|
$7,069.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.02 |
| Max. Negotiated Rate |
$6,786.62 |
| Rate for Payer: Aetna Commercial |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,514.13
|
| Rate for Payer: Cash Price |
$3,534.70
|
| Rate for Payer: Cigna Commercial |
$5,867.60
|
| Rate for Payer: First Health Commercial |
$6,715.93
|
| Rate for Payer: Humana Commercial |
$6,008.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,796.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,217.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,120.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,221.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,302.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,191.51
|
| Rate for Payer: PHCS Commercial |
$6,786.62
|
| Rate for Payer: United Healthcare All Payer |
$6,221.07
|
|
|
TRIATHLON POST AUG SZ 6 10MM
|
Facility
|
OP
|
$7,069.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.02 |
| Max. Negotiated Rate |
$6,786.62 |
| Rate for Payer: Aetna Commercial |
$5,443.44
|
| Rate for Payer: Anthem Medicaid |
$2,431.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,514.13
|
| Rate for Payer: Cash Price |
$3,534.70
|
| Rate for Payer: Cigna Commercial |
$5,867.60
|
| Rate for Payer: First Health Commercial |
$6,715.93
|
| Rate for Payer: Humana Commercial |
$6,008.99
|
| Rate for Payer: Humana KY Medicaid |
$2,431.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,455.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,796.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,217.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,120.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,479.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,221.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,302.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,191.51
|
| Rate for Payer: PHCS Commercial |
$6,786.62
|
| Rate for Payer: United Healthcare All Payer |
$6,221.07
|
|
|
TRIATHLON POST AUG SZ 6 5MM
|
Facility
|
IP
|
$7,267.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.73 |
| Max. Negotiated Rate |
$6,976.44 |
| Rate for Payer: Aetna Commercial |
$5,595.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.36
|
| Rate for Payer: Cash Price |
$3,633.56
|
| Rate for Payer: Cigna Commercial |
$6,031.72
|
| Rate for Payer: First Health Commercial |
$6,903.77
|
| Rate for Payer: Humana Commercial |
$6,177.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.81
|
| Rate for Payer: PHCS Commercial |
$6,976.44
|
| Rate for Payer: United Healthcare All Payer |
$6,395.07
|
|
|
TRIATHLON POST AUG SZ 6 5MM
|
Facility
|
OP
|
$7,267.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.73 |
| Max. Negotiated Rate |
$6,976.44 |
| Rate for Payer: Aetna Commercial |
$5,595.69
|
| Rate for Payer: Anthem Medicaid |
$2,499.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,668.36
|
| Rate for Payer: Cash Price |
$3,633.56
|
| Rate for Payer: Cigna Commercial |
$6,031.72
|
| Rate for Payer: First Health Commercial |
$6,903.77
|
| Rate for Payer: Humana Commercial |
$6,177.06
|
| Rate for Payer: Humana KY Medicaid |
$2,499.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,959.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,363.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,450.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,252.81
|
| Rate for Payer: PHCS Commercial |
$6,976.44
|
| Rate for Payer: United Healthcare All Payer |
$6,395.07
|
|
|
TRIATHLON POST AUG SZ 7 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 7 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 7 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 7 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 8 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 8 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 8 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 8 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 PRIMARY TIB BASE #1
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON PRIMARY TIB BASE #1
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON PRIMARY TIB BASE #2
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #2
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #3
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #3
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #4
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #4
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #6
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON PRIMARY TIB BASE #6
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
