|
TRIATHLON CR TIB INSRT X3 #4-9
|
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 INSRT X3 #5-1
|
Facility
|
OP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON CR TIB INSRT X3 #5-1
|
Facility
|
IP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON CR TIB INSRT X3 #5-9
|
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 INSRT X3 #5-9
|
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 INSRT X3 #6-1
|
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: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| 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 HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INSRT X3 #6-1
|
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: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| 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 HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| 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 Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON CR TIB INSRT X3 #6-9
|
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 INSRT X3 #6-9
|
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 INSRT X3 #7-9
|
Facility
|
IP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIATHLON CR TIB INSRT X3 #7-9
|
Facility
|
OP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem Medicaid |
$2,728.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Humana KY Medicaid |
$2,728.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
TRIATHLON CR TIB INST X3#2-11M
|
Facility
|
OP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON CR TIB INST X3#2-11M
|
Facility
|
IP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON FEM DIS AUG 10MM #4
|
Facility
|
IP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLON FEM DIS AUG 10MM #4
|
Facility
|
OP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem Medicaid |
$2,918.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Humana KY Medicaid |
$2,918.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLON FEM DIS AUG 5MM #1 L
|
Facility
|
OP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem Medicaid |
$2,655.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Humana KY Medicaid |
$2,655.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #1 L
|
Facility
|
IP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #1 R
|
Facility
|
OP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem Medicaid |
$2,655.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Humana KY Medicaid |
$2,655.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #1 R
|
Facility
|
IP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 L
|
Facility
|
IP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 L
|
Facility
|
OP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem Medicaid |
$2,655.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Humana KY Medicaid |
$2,655.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 R
|
Facility
|
IP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 R
|
Facility
|
OP
|
$7,721.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,316.49 |
| Max. Negotiated Rate |
$7,412.77 |
| Rate for Payer: Aetna Commercial |
$5,945.66
|
| Rate for Payer: Anthem Medicaid |
$2,655.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,022.88
|
| Rate for Payer: Cash Price |
$3,860.82
|
| Rate for Payer: Cigna Commercial |
$6,408.96
|
| Rate for Payer: First Health Commercial |
$7,335.56
|
| Rate for Payer: Humana Commercial |
$6,563.39
|
| Rate for Payer: Humana KY Medicaid |
$2,655.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,331.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,698.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,177.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,717.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,327.93
|
| Rate for Payer: PHCS Commercial |
$7,412.77
|
| Rate for Payer: United Healthcare All Payer |
$6,795.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 L
|
Facility
|
OP
|
$7,826.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.92 |
| Max. Negotiated Rate |
$7,513.34 |
| Rate for Payer: Aetna Commercial |
$6,026.33
|
| Rate for Payer: Anthem Medicaid |
$2,691.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,104.59
|
| Rate for Payer: Cash Price |
$3,913.20
|
| Rate for Payer: Cigna Commercial |
$6,495.91
|
| Rate for Payer: First Health Commercial |
$7,435.08
|
| Rate for Payer: Humana Commercial |
$6,652.44
|
| Rate for Payer: Humana KY Medicaid |
$2,691.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,417.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,745.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,887.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,869.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,400.22
|
| Rate for Payer: PHCS Commercial |
$7,513.34
|
| Rate for Payer: United Healthcare All Payer |
$6,887.23
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 L
|
Facility
|
IP
|
$7,826.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.92 |
| Max. Negotiated Rate |
$7,513.34 |
| Rate for Payer: Aetna Commercial |
$6,026.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,104.59
|
| Rate for Payer: Cash Price |
$3,913.20
|
| Rate for Payer: Cigna Commercial |
$6,495.91
|
| Rate for Payer: First Health Commercial |
$7,435.08
|
| Rate for Payer: Humana Commercial |
$6,652.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,417.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,887.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,869.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,400.22
|
| Rate for Payer: PHCS Commercial |
$7,513.34
|
| Rate for Payer: United Healthcare All Payer |
$6,887.23
|
|
