|
TRIATHLON PRIMARY TIB BASE #7
|
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 #7
|
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 #8
|
Facility
|
IP
|
$7,733.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.30 |
| Max. Negotiated Rate |
$7,423.73 |
| Rate for Payer: Aetna Commercial |
$5,954.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.78
|
| Rate for Payer: Cash Price |
$3,866.52
|
| Rate for Payer: Cigna Commercial |
$6,418.43
|
| Rate for Payer: First Health Commercial |
$7,346.40
|
| Rate for Payer: Humana Commercial |
$6,573.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.25
|
| Rate for Payer: PHCS Commercial |
$7,423.73
|
| Rate for Payer: United Healthcare All Payer |
$6,805.08
|
|
|
TRIATHLON PRIMARY TIB BASE #8
|
Facility
|
OP
|
$7,733.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.30 |
| Max. Negotiated Rate |
$7,423.73 |
| Rate for Payer: Aetna Commercial |
$5,954.45
|
| Rate for Payer: Anthem Medicaid |
$2,659.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.78
|
| Rate for Payer: Cash Price |
$3,866.52
|
| Rate for Payer: Cigna Commercial |
$6,418.43
|
| Rate for Payer: First Health Commercial |
$7,346.40
|
| Rate for Payer: Humana Commercial |
$6,573.09
|
| Rate for Payer: Humana KY Medicaid |
$2,659.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,686.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.25
|
| Rate for Payer: PHCS Commercial |
$7,423.73
|
| Rate for Payer: United Healthcare All Payer |
$6,805.08
|
|
|
TRIATHLON PS FEM COMP #1 LEFT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #1 LEFT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #1 RIGHT
|
Facility
|
IP
|
$16,702.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.27 |
| Max. Negotiated Rate |
$16,034.00 |
| Rate for Payer: Aetna Commercial |
$12,860.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.62
|
| Rate for Payer: Cash Price |
$8,351.04
|
| Rate for Payer: Cigna Commercial |
$13,862.73
|
| Rate for Payer: First Health Commercial |
$15,866.98
|
| Rate for Payer: Humana Commercial |
$14,196.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.83
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,171.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,177.64
|
| Rate for Payer: PHCS Commercial |
$16,034.00
|
| Rate for Payer: United Healthcare All Payer |
$14,697.83
|
|
|
TRIATHLON PS FEM COMP #1 RIGHT
|
Facility
|
OP
|
$16,702.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.27 |
| Max. Negotiated Rate |
$16,034.00 |
| Rate for Payer: Aetna Commercial |
$12,860.60
|
| Rate for Payer: Anthem Medicaid |
$5,743.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.62
|
| Rate for Payer: Cash Price |
$8,351.04
|
| Rate for Payer: Cigna Commercial |
$13,862.73
|
| Rate for Payer: First Health Commercial |
$15,866.98
|
| Rate for Payer: Humana Commercial |
$14,196.77
|
| Rate for Payer: Humana KY Medicaid |
$5,743.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.83
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,171.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,177.64
|
| Rate for Payer: PHCS Commercial |
$16,034.00
|
| Rate for Payer: United Healthcare All Payer |
$14,697.83
|
|
|
TRIATHLON PS FEM COMP #2 LEFT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #2 LEFT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #2 RIGHT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #2 RIGHT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #3 LEFT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #3 LEFT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #3 RIGHT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #3 RIGHT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #4 LEFT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #4 LEFT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #4 RIGHT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #4 RIGHT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #5 LEFT
|
Facility
|
OP
|
$11,192.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.07 |
| Max. Negotiated Rate |
$10,745.12 |
| Rate for Payer: Aetna Commercial |
$8,618.48
|
| Rate for Payer: Anthem Medicaid |
$3,849.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.41
|
| Rate for Payer: Cash Price |
$5,596.42
|
| Rate for Payer: Cigna Commercial |
$9,290.05
|
| Rate for Payer: First Health Commercial |
$10,633.19
|
| Rate for Payer: Humana Commercial |
$9,513.91
|
| Rate for Payer: Humana KY Medicaid |
$3,849.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,469.78
|
| Rate for Payer: PHCS Commercial |
$10,745.12
|
| Rate for Payer: United Healthcare All Payer |
$9,849.69
|
|
|
TRIATHLON PS FEM COMP #5 LEFT
|
Facility
|
IP
|
$11,192.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.07 |
| Max. Negotiated Rate |
$10,745.12 |
| Rate for Payer: Aetna Commercial |
$8,618.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.41
|
| Rate for Payer: Cash Price |
$5,596.42
|
| Rate for Payer: Cigna Commercial |
$9,290.05
|
| Rate for Payer: First Health Commercial |
$10,633.19
|
| Rate for Payer: Humana Commercial |
$9,513.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,469.78
|
| Rate for Payer: PHCS Commercial |
$10,745.12
|
| Rate for Payer: United Healthcare All Payer |
$9,849.69
|
|
|
TRIATHLON PS FEM COMP #5 RIGHT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #5 RIGHT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #6 LEFT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
