|
TRIATHLON PS FEM COMP #1 LEFT
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #1 LEFT
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #1 RIGHT
|
Facility
|
IP
|
$17,249.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,174.81 |
| Max. Negotiated Rate |
$16,559.39 |
| Rate for Payer: Aetna Commercial |
$13,282.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,454.50
|
| Rate for Payer: Cash Price |
$8,624.68
|
| Rate for Payer: Cigna Commercial |
$14,316.97
|
| Rate for Payer: First Health Commercial |
$16,386.89
|
| Rate for Payer: Humana Commercial |
$14,661.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,144.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,730.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,174.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,179.44
|
| Rate for Payer: Ohio Health Group HMO |
$12,937.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,006.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,902.06
|
| Rate for Payer: PHCS Commercial |
$16,559.39
|
| Rate for Payer: United Healthcare All Payer |
$15,179.44
|
|
|
TRIATHLON PS FEM COMP #1 RIGHT
|
Facility
|
OP
|
$17,249.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,174.81 |
| Max. Negotiated Rate |
$16,559.39 |
| Rate for Payer: Aetna Commercial |
$13,282.01
|
| Rate for Payer: Anthem Medicaid |
$5,932.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,454.50
|
| Rate for Payer: Cash Price |
$8,624.68
|
| Rate for Payer: Cigna Commercial |
$14,316.97
|
| Rate for Payer: First Health Commercial |
$16,386.89
|
| Rate for Payer: Humana Commercial |
$14,661.96
|
| Rate for Payer: Humana KY Medicaid |
$5,932.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,992.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,144.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,730.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,174.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,051.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,179.44
|
| Rate for Payer: Ohio Health Group HMO |
$12,937.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,799.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,006.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,902.06
|
| Rate for Payer: PHCS Commercial |
$16,559.39
|
| Rate for Payer: United Healthcare All Payer |
$15,179.44
|
|
|
TRIATHLON PS FEM COMP #2 LEFT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #2 LEFT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #2 RIGHT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #2 RIGHT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #3 LEFT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #3 LEFT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #3 RIGHT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #3 RIGHT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #4 LEFT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #4 LEFT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #4 RIGHT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #4 RIGHT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #5 LEFT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #5 LEFT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #5 RIGHT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #5 RIGHT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #6 LEFT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #6 LEFT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #6 RIGHT
|
Facility
|
IP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #6 RIGHT
|
Facility
|
OP
|
$11,356.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.02 |
| Max. Negotiated Rate |
$10,902.47 |
| Rate for Payer: Aetna Commercial |
$8,744.69
|
| Rate for Payer: Anthem Medicaid |
$3,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,858.26
|
| Rate for Payer: Cash Price |
$5,678.37
|
| Rate for Payer: Cigna Commercial |
$9,426.09
|
| Rate for Payer: First Health Commercial |
$10,788.90
|
| Rate for Payer: Humana Commercial |
$9,653.23
|
| Rate for Payer: Humana KY Medicaid |
$3,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,945.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,312.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,381.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,407.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,983.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,993.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,517.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,085.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,880.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,836.15
|
| Rate for Payer: PHCS Commercial |
$10,902.47
|
| Rate for Payer: United Healthcare All Payer |
$9,993.93
|
|
|
TRIATHLON PS FEM COMP #7 LEFT
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
