|
TRIATHLON CR FEM COMP BEAD 4R
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 4R
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 5L
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 5L
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 5R
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 5R
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 6L
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 6L
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 6R
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 6R
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 7L
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 7L
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 7R
|
Facility
|
OP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem Medicaid |
$4,918.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Humana KY Medicaid |
$4,918.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,017.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 7R
|
Facility
|
IP
|
$14,303.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,290.90 |
| Max. Negotiated Rate |
$13,730.89 |
| Rate for Payer: Aetna Commercial |
$11,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,156.35
|
| Rate for Payer: Cash Price |
$7,151.51
|
| Rate for Payer: Cigna Commercial |
$11,871.50
|
| Rate for Payer: First Health Commercial |
$13,587.86
|
| Rate for Payer: Humana Commercial |
$12,157.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,728.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,555.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,290.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,586.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,727.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,869.08
|
| Rate for Payer: PHCS Commercial |
$13,730.89
|
| Rate for Payer: United Healthcare All Payer |
$12,586.65
|
|
|
TRIATHLON CR FEM COMP BEAD 8L
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRIATHLON CR FEM COMP BEAD 8L
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRIATHLON CR FEM COMP BEAD 8R
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRIATHLON CR FEM COMP BEAD 8R
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRIATHLON CR TB INSRT X3 #2-9M
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TB INSRT X3 #2-9M
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INRT X3 #3-11
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INRT X3 #3-11
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INRT X3 #4-11
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INRT X3 #4-11
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INSERT #1-9MM
|
Facility
|
OP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem Medicaid |
$3,032.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Humana KY Medicaid |
$3,032.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
