|
TRIATHLON FEM DIS AUG 5MM #3 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 #3 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 #4 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
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 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 #4 R
|
Facility
|
OP
|
$8,222.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,466.73 |
| Max. Negotiated Rate |
$7,893.52 |
| Rate for Payer: Aetna Commercial |
$6,331.26
|
| Rate for Payer: Anthem Medicaid |
$2,827.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,413.49
|
| Rate for Payer: Cash Price |
$4,111.21
|
| Rate for Payer: Cigna Commercial |
$6,824.61
|
| Rate for Payer: First Health Commercial |
$7,811.30
|
| Rate for Payer: Humana Commercial |
$6,989.06
|
| Rate for Payer: Humana KY Medicaid |
$2,827.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,856.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,742.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,068.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,884.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,235.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,166.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,577.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,153.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,673.47
|
| Rate for Payer: PHCS Commercial |
$7,893.52
|
| Rate for Payer: United Healthcare All Payer |
$7,235.73
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 R
|
Facility
|
IP
|
$8,222.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,466.73 |
| Max. Negotiated Rate |
$7,893.52 |
| Rate for Payer: Aetna Commercial |
$6,331.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,413.49
|
| Rate for Payer: Cash Price |
$4,111.21
|
| Rate for Payer: Cigna Commercial |
$6,824.61
|
| Rate for Payer: First Health Commercial |
$7,811.30
|
| Rate for Payer: Humana Commercial |
$6,989.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,742.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,068.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,235.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,166.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,577.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,153.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,673.47
|
| Rate for Payer: PHCS Commercial |
$7,893.52
|
| Rate for Payer: United Healthcare All Payer |
$7,235.73
|
|
|
TRIATHLON FEM DIS AUG 5MM #5 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 #5 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 #5 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 #5 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 #6 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 #6 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 #6 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 #6 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 #7 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 #7 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 #7 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 #7 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 #8 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 #8 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 #8 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 #8 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 HINGE BUMPER
|
Facility
|
IP
|
$6,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.81 |
| Max. Negotiated Rate |
$6,690.60 |
| Rate for Payer: Aetna Commercial |
$5,366.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,436.12
|
| Rate for Payer: Cash Price |
$3,484.69
|
| Rate for Payer: Cigna Commercial |
$5,784.59
|
| Rate for Payer: First Health Commercial |
$6,620.91
|
| Rate for Payer: Humana Commercial |
$5,923.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,133.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,227.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,063.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,808.87
|
| Rate for Payer: PHCS Commercial |
$6,690.60
|
| Rate for Payer: United Healthcare All Payer |
$6,133.05
|
|
|
TRIATHLON HINGE BUMPER
|
Facility
|
OP
|
$6,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.81 |
| Max. Negotiated Rate |
$6,690.60 |
| Rate for Payer: Aetna Commercial |
$5,366.42
|
| Rate for Payer: Anthem Medicaid |
$2,396.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,436.12
|
| Rate for Payer: Cash Price |
$3,484.69
|
| Rate for Payer: Cigna Commercial |
$5,784.59
|
| Rate for Payer: First Health Commercial |
$6,620.91
|
| Rate for Payer: Humana Commercial |
$5,923.97
|
| Rate for Payer: Humana KY Medicaid |
$2,396.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,421.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,444.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,133.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,227.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,063.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,808.87
|
| Rate for Payer: PHCS Commercial |
$6,690.60
|
| Rate for Payer: United Healthcare All Payer |
$6,133.05
|
|
|
TRIATHLON HINGE INSERT
|
Facility
|
OP
|
$14,270.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,281.16 |
| Max. Negotiated Rate |
$13,699.71 |
| Rate for Payer: Aetna Commercial |
$10,988.31
|
| Rate for Payer: Anthem Medicaid |
$4,907.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,131.01
|
| Rate for Payer: Cash Price |
$7,135.27
|
| Rate for Payer: Cigna Commercial |
$11,844.54
|
| Rate for Payer: First Health Commercial |
$13,557.00
|
| Rate for Payer: Humana Commercial |
$12,129.95
|
| Rate for Payer: Humana KY Medicaid |
$4,907.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,957.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,701.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,531.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,281.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,006.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,558.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,702.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,416.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,415.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,846.67
|
| Rate for Payer: PHCS Commercial |
$13,699.71
|
| Rate for Payer: United Healthcare All Payer |
$12,558.07
|
|
