|
TRIATHLON PATELLA S39X11X3
|
Facility
|
OP
|
$4,925.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.79 |
| Max. Negotiated Rate |
$4,728.94 |
| Rate for Payer: Aetna Commercial |
$3,793.00
|
| Rate for Payer: Anthem Medicaid |
$1,694.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.26
|
| Rate for Payer: Cash Price |
$2,462.99
|
| Rate for Payer: Cigna Commercial |
$4,088.56
|
| Rate for Payer: First Health Commercial |
$4,679.68
|
| Rate for Payer: Humana Commercial |
$4,187.08
|
| Rate for Payer: Humana KY Medicaid |
$1,694.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,711.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,728.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,285.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.93
|
| Rate for Payer: PHCS Commercial |
$4,728.94
|
| Rate for Payer: United Healthcare All Payer |
$4,334.86
|
|
|
TRIATHLON PATELLA S39X11X3
|
Facility
|
IP
|
$4,925.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.79 |
| Max. Negotiated Rate |
$4,728.94 |
| Rate for Payer: Aetna Commercial |
$3,793.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.26
|
| Rate for Payer: Cash Price |
$2,462.99
|
| Rate for Payer: Cigna Commercial |
$4,088.56
|
| Rate for Payer: First Health Commercial |
$4,679.68
|
| Rate for Payer: Humana Commercial |
$4,187.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,285.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.93
|
| Rate for Payer: PHCS Commercial |
$4,728.94
|
| Rate for Payer: United Healthcare All Payer |
$4,334.86
|
|
|
TRIATHLON POST AUG SZ 1 10MM
|
Facility
|
IP
|
$7,960.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.11 |
| Max. Negotiated Rate |
$7,641.94 |
| Rate for Payer: Aetna Commercial |
$6,129.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,209.07
|
| Rate for Payer: Cash Price |
$3,980.18
|
| Rate for Payer: Cigna Commercial |
$6,607.09
|
| Rate for Payer: First Health Commercial |
$7,562.33
|
| Rate for Payer: Humana Commercial |
$6,766.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,527.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,874.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,005.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,970.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,368.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,925.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,492.64
|
| Rate for Payer: PHCS Commercial |
$7,641.94
|
| Rate for Payer: United Healthcare All Payer |
$7,005.11
|
|
|
TRIATHLON POST AUG SZ 1 10MM
|
Facility
|
OP
|
$7,960.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.11 |
| Max. Negotiated Rate |
$7,641.94 |
| Rate for Payer: Aetna Commercial |
$6,129.47
|
| Rate for Payer: Anthem Medicaid |
$2,737.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,209.07
|
| Rate for Payer: Cash Price |
$3,980.18
|
| Rate for Payer: Cigna Commercial |
$6,607.09
|
| Rate for Payer: First Health Commercial |
$7,562.33
|
| Rate for Payer: Humana Commercial |
$6,766.30
|
| Rate for Payer: Humana KY Medicaid |
$2,737.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,765.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,527.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,874.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,792.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,005.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,970.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,368.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,925.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,492.64
|
| Rate for Payer: PHCS Commercial |
$7,641.94
|
| Rate for Payer: United Healthcare All Payer |
$7,005.11
|
|
|
TRIATHLON POST AUG SZ 1 5MM
|
Facility
|
OP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem Medicaid |
$2,672.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Humana KY Medicaid |
$2,672.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,699.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,725.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLON POST AUG SZ 1 5MM
|
Facility
|
IP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLON POST AUG SZ 2 10MM
|
Facility
|
IP
|
$7,960.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.11 |
| Max. Negotiated Rate |
$7,641.94 |
| Rate for Payer: Aetna Commercial |
$6,129.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,209.07
|
| Rate for Payer: Cash Price |
$3,980.18
|
| Rate for Payer: Cigna Commercial |
$6,607.09
|
| Rate for Payer: First Health Commercial |
$7,562.33
|
| Rate for Payer: Humana Commercial |
$6,766.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,527.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,874.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,005.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,970.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,368.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,925.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,492.64
|
| Rate for Payer: PHCS Commercial |
$7,641.94
|
| Rate for Payer: United Healthcare All Payer |
$7,005.11
|
|
|
TRIATHLON POST AUG SZ 2 10MM
|
Facility
|
OP
|
$7,960.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.11 |
| Max. Negotiated Rate |
$7,641.94 |
| Rate for Payer: Aetna Commercial |
$6,129.47
|
| Rate for Payer: Anthem Medicaid |
$2,737.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,209.07
|
| Rate for Payer: Cash Price |
$3,980.18
|
| Rate for Payer: Cigna Commercial |
$6,607.09
|
| Rate for Payer: First Health Commercial |
$7,562.33
|
| Rate for Payer: Humana Commercial |
$6,766.30
|
| Rate for Payer: Humana KY Medicaid |
$2,737.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,765.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,527.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,874.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,792.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,005.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,970.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,368.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,925.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,492.64
|
| Rate for Payer: PHCS Commercial |
$7,641.94
|
| Rate for Payer: United Healthcare All Payer |
$7,005.11
|
|
|
TRIATHLON POST AUG SZ 2 5MM
|
Facility
|
IP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLON POST AUG SZ 2 5MM
|
Facility
|
OP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem Medicaid |
$2,672.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Humana KY Medicaid |
$2,672.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,699.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,725.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLON POST AUG SZ 3 10MM
|
Facility
|
IP
|
$7,961.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.54 |
| Max. Negotiated Rate |
$7,643.34 |
| Rate for Payer: Aetna Commercial |
$6,130.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,210.21
|
| Rate for Payer: Cash Price |
$3,980.91
|
| Rate for Payer: Cigna Commercial |
$6,608.30
|
| Rate for Payer: First Health Commercial |
$7,563.72
|
| Rate for Payer: Humana Commercial |
$6,767.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,875.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,006.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,971.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,369.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,926.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,493.65
|
| Rate for Payer: PHCS Commercial |
$7,643.34
|
| Rate for Payer: United Healthcare All Payer |
$7,006.39
|
|
|
TRIATHLON POST AUG SZ 3 10MM
|
Facility
|
OP
|
$7,961.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.54 |
| Max. Negotiated Rate |
$7,643.34 |
| Rate for Payer: Aetna Commercial |
$6,130.59
|
| Rate for Payer: Anthem Medicaid |
$2,738.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,210.21
|
| Rate for Payer: Cash Price |
$3,980.91
|
| Rate for Payer: Cigna Commercial |
$6,608.30
|
| Rate for Payer: First Health Commercial |
$7,563.72
|
| Rate for Payer: Humana Commercial |
$6,767.54
|
| Rate for Payer: Humana KY Medicaid |
$2,738.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,765.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,875.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,006.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,971.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,369.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,926.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,493.65
|
| Rate for Payer: PHCS Commercial |
$7,643.34
|
| Rate for Payer: United Healthcare All Payer |
$7,006.39
|
|
|
TRIATHLON POST AUG SZ 3 5MM
|
Facility
|
OP
|
$7,622.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,286.60 |
| Max. Negotiated Rate |
$7,317.12 |
| Rate for Payer: Aetna Commercial |
$5,868.94
|
| Rate for Payer: Anthem Medicaid |
$2,621.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,945.16
|
| Rate for Payer: Cash Price |
$3,811.00
|
| Rate for Payer: Cigna Commercial |
$6,326.26
|
| Rate for Payer: First Health Commercial |
$7,240.90
|
| Rate for Payer: Humana Commercial |
$6,478.70
|
| Rate for Payer: Humana KY Medicaid |
$2,621.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,647.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,250.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,673.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,707.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,716.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.18
|
| Rate for Payer: PHCS Commercial |
$7,317.12
|
| Rate for Payer: United Healthcare All Payer |
$6,707.36
|
|
|
TRIATHLON POST AUG SZ 3 5MM
|
Facility
|
IP
|
$7,622.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,286.60 |
| Max. Negotiated Rate |
$7,317.12 |
| Rate for Payer: Aetna Commercial |
$5,868.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,945.16
|
| Rate for Payer: Cash Price |
$3,811.00
|
| Rate for Payer: Cigna Commercial |
$6,326.26
|
| Rate for Payer: First Health Commercial |
$7,240.90
|
| Rate for Payer: Humana Commercial |
$6,478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,250.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,707.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,716.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.18
|
| Rate for Payer: PHCS Commercial |
$7,317.12
|
| Rate for Payer: United Healthcare All Payer |
$6,707.36
|
|
|
TRIATHLON POST AUG SZ 4 10MM
|
Facility
|
IP
|
$7,380.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.03 |
| Max. Negotiated Rate |
$7,084.91 |
| Rate for Payer: Aetna Commercial |
$5,682.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.49
|
| Rate for Payer: Cash Price |
$3,690.05
|
| Rate for Payer: Cigna Commercial |
$6,125.49
|
| Rate for Payer: First Health Commercial |
$7,011.10
|
| Rate for Payer: Humana Commercial |
$6,273.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.28
|
| Rate for Payer: PHCS Commercial |
$7,084.91
|
| Rate for Payer: United Healthcare All Payer |
$6,494.50
|
|
|
TRIATHLON POST AUG SZ 4 10MM
|
Facility
|
OP
|
$7,380.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.03 |
| Max. Negotiated Rate |
$7,084.91 |
| Rate for Payer: Aetna Commercial |
$5,682.68
|
| Rate for Payer: Anthem Medicaid |
$2,538.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.49
|
| Rate for Payer: Cash Price |
$3,690.05
|
| Rate for Payer: Cigna Commercial |
$6,125.49
|
| Rate for Payer: First Health Commercial |
$7,011.10
|
| Rate for Payer: Humana Commercial |
$6,273.09
|
| Rate for Payer: Humana KY Medicaid |
$2,538.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.28
|
| Rate for Payer: PHCS Commercial |
$7,084.91
|
| Rate for Payer: United Healthcare All Payer |
$6,494.50
|
|
|
TRIATHLON POST AUG SZ 4 5MM
|
Facility
|
OP
|
$7,645.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.72 |
| Max. Negotiated Rate |
$7,339.89 |
| Rate for Payer: Aetna Commercial |
$5,887.20
|
| Rate for Payer: Anthem Medicaid |
$2,629.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,963.66
|
| Rate for Payer: Cash Price |
$3,822.86
|
| Rate for Payer: Cigna Commercial |
$6,345.95
|
| Rate for Payer: First Health Commercial |
$7,263.43
|
| Rate for Payer: Humana Commercial |
$6,498.86
|
| Rate for Payer: Humana KY Medicaid |
$2,629.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,269.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,642.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,728.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,116.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,651.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,275.55
|
| Rate for Payer: PHCS Commercial |
$7,339.89
|
| Rate for Payer: United Healthcare All Payer |
$6,728.23
|
|
|
TRIATHLON POST AUG SZ 4 5MM
|
Facility
|
IP
|
$7,645.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.72 |
| Max. Negotiated Rate |
$7,339.89 |
| Rate for Payer: Aetna Commercial |
$5,887.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,963.66
|
| Rate for Payer: Cash Price |
$3,822.86
|
| Rate for Payer: Cigna Commercial |
$6,345.95
|
| Rate for Payer: First Health Commercial |
$7,263.43
|
| Rate for Payer: Humana Commercial |
$6,498.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,269.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,642.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,728.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,116.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,651.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,275.55
|
| Rate for Payer: PHCS Commercial |
$7,339.89
|
| Rate for Payer: United Healthcare All Payer |
$6,728.23
|
|
|
TRIATHLON POST AUG SZ 5 10MM
|
Facility
|
OP
|
$7,380.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.03 |
| Max. Negotiated Rate |
$7,084.91 |
| Rate for Payer: Aetna Commercial |
$5,682.68
|
| Rate for Payer: Anthem Medicaid |
$2,538.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.49
|
| Rate for Payer: Cash Price |
$3,690.05
|
| Rate for Payer: Cigna Commercial |
$6,125.49
|
| Rate for Payer: First Health Commercial |
$7,011.10
|
| Rate for Payer: Humana Commercial |
$6,273.09
|
| Rate for Payer: Humana KY Medicaid |
$2,538.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.28
|
| Rate for Payer: PHCS Commercial |
$7,084.91
|
| Rate for Payer: United Healthcare All Payer |
$6,494.50
|
|
|
TRIATHLON POST AUG SZ 5 10MM
|
Facility
|
IP
|
$7,380.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.03 |
| Max. Negotiated Rate |
$7,084.91 |
| Rate for Payer: Aetna Commercial |
$5,682.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.49
|
| Rate for Payer: Cash Price |
$3,690.05
|
| Rate for Payer: Cigna Commercial |
$6,125.49
|
| Rate for Payer: First Health Commercial |
$7,011.10
|
| Rate for Payer: Humana Commercial |
$6,273.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.28
|
| Rate for Payer: PHCS Commercial |
$7,084.91
|
| Rate for Payer: United Healthcare All Payer |
$6,494.50
|
|
|
TRIATHLON POST AUG SZ 5 5MM
|
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 POST AUG SZ 5 5MM
|
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 POST AUG SZ 6 10MM
|
Facility
|
OP
|
$7,269.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,180.82 |
| Max. Negotiated Rate |
$6,978.62 |
| Rate for Payer: Aetna Commercial |
$5,597.44
|
| Rate for Payer: Anthem Medicaid |
$2,499.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,670.13
|
| Rate for Payer: Cash Price |
$3,634.70
|
| Rate for Payer: Cigna Commercial |
$6,033.60
|
| Rate for Payer: First Health Commercial |
$6,905.93
|
| Rate for Payer: Humana Commercial |
$6,178.99
|
| Rate for Payer: Humana KY Medicaid |
$2,499.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,550.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,397.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,452.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,815.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,324.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.89
|
| Rate for Payer: PHCS Commercial |
$6,978.62
|
| Rate for Payer: United Healthcare All Payer |
$6,397.07
|
|
|
TRIATHLON POST AUG SZ 6 10MM
|
Facility
|
IP
|
$7,269.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,180.82 |
| Max. Negotiated Rate |
$6,978.62 |
| Rate for Payer: Aetna Commercial |
$5,597.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,670.13
|
| Rate for Payer: Cash Price |
$3,634.70
|
| Rate for Payer: Cigna Commercial |
$6,033.60
|
| Rate for Payer: First Health Commercial |
$6,905.93
|
| Rate for Payer: Humana Commercial |
$6,178.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,397.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,452.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,815.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,324.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.89
|
| Rate for Payer: PHCS Commercial |
$6,978.62
|
| Rate for Payer: United Healthcare All Payer |
$6,397.07
|
|
|
TRIATHLON POST AUG SZ 6 5MM
|
Facility
|
IP
|
$7,467.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.14 |
| Max. Negotiated Rate |
$7,168.44 |
| Rate for Payer: Aetna Commercial |
$5,749.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.36
|
| Rate for Payer: Cash Price |
$3,733.56
|
| Rate for Payer: Cigna Commercial |
$6,197.72
|
| Rate for Payer: First Health Commercial |
$7,093.77
|
| Rate for Payer: Humana Commercial |
$6,347.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,510.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,973.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.32
|
| Rate for Payer: PHCS Commercial |
$7,168.44
|
| Rate for Payer: United Healthcare All Payer |
$6,571.07
|
|
