|
TRIATHLON ASYM PAT A40M*11M
|
Facility
|
IP
|
$4,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$4,713.60 |
| Rate for Payer: Aetna Commercial |
$3,780.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,829.80
|
| Rate for Payer: Cash Price |
$2,455.00
|
| Rate for Payer: Cigna Commercial |
$4,075.30
|
| Rate for Payer: First Health Commercial |
$4,664.50
|
| Rate for Payer: Humana Commercial |
$4,173.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,026.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,623.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,320.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,928.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,387.90
|
| Rate for Payer: PHCS Commercial |
$4,713.60
|
| Rate for Payer: United Healthcare All Payer |
$4,320.80
|
|
|
TRIATHLON ASYM PAT A40M*11M
|
Facility
|
OP
|
$4,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$4,713.60 |
| Rate for Payer: Aetna Commercial |
$3,780.70
|
| Rate for Payer: Anthem Medicaid |
$1,688.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,829.80
|
| Rate for Payer: Cash Price |
$2,455.00
|
| Rate for Payer: Cigna Commercial |
$4,075.30
|
| Rate for Payer: First Health Commercial |
$4,664.50
|
| Rate for Payer: Humana Commercial |
$4,173.50
|
| Rate for Payer: Humana KY Medicaid |
$1,688.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,705.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,026.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,623.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,722.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,320.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,928.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,387.90
|
| Rate for Payer: PHCS Commercial |
$4,713.60
|
| Rate for Payer: United Healthcare All Payer |
$4,320.80
|
|
|
TRIATHLON CEMENTED STEM
|
Facility
|
OP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem Medicaid |
$2,388.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Humana KY Medicaid |
$2,388.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,436.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRIATHLON CEMENTED STEM
|
Facility
|
IP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
TRIATHLON CR FEM COMP #1 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #1 LT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #1 RT
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON CR FEM COMP #1 RT
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON CR FEM COMP #2 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #2 LT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #2 RT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #2 RT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #3 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #3 LT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #3 RT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #3 RT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #4 LT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #4 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #4 RT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #4 RT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #5 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #5 LT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #5 RT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #5 RT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON CR FEM COMP #6 LT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
