|
TRIATHLON POST AUG SZ 6 5MM
|
Facility
|
OP
|
$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 Medicaid |
$2,567.95
|
| 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: Humana KY Medicaid |
$2,567.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.08
|
| 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: Molina Healthcare Medicaid |
$2,619.47
|
| 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
|
|
|
TRIATHLON POST AUG SZ 7 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 7 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 7 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 7 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 8 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 8 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 8 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 8 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 PRIMARY TIB BASE #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 PRIMARY TIB BASE #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 PRIMARY TIB BASE #2
|
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 PRIMARY TIB BASE #2
|
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 PRIMARY TIB BASE #3
|
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 PRIMARY TIB BASE #3
|
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 PRIMARY TIB BASE #4
|
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 PRIMARY TIB BASE #4
|
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 PRIMARY TIB BASE #5
|
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 PRIMARY TIB BASE #5
|
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 PRIMARY TIB BASE #6
|
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 PRIMARY TIB BASE #6
|
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 PRIMARY TIB BASE #7
|
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 PRIMARY TIB BASE #7
|
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 PRIMARY TIB BASE #8
|
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 PRIMARY TIB BASE #8
|
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
|
|
