|
TRIATHION PATELLA A38*11MM
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHION PATELLA A38*11MM
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLN CR TIB INSRT X3 #1-9M
|
Facility
|
IP
|
$11,765.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.46 |
| Max. Negotiated Rate |
$11,294.48 |
| Rate for Payer: Aetna Commercial |
$9,059.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.76
|
| Rate for Payer: Cash Price |
$5,882.54
|
| Rate for Payer: Cigna Commercial |
$9,765.02
|
| Rate for Payer: First Health Commercial |
$11,176.83
|
| Rate for Payer: Humana Commercial |
$10,000.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,647.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,353.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,647.17
|
| Rate for Payer: PHCS Commercial |
$11,294.48
|
| Rate for Payer: United Healthcare All Payer |
$10,353.27
|
|
|
TRIATHLN CR TIB INSRT X3 #1-9M
|
Facility
|
OP
|
$11,765.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.46 |
| Max. Negotiated Rate |
$11,294.48 |
| Rate for Payer: Aetna Commercial |
$9,059.11
|
| Rate for Payer: Anthem Medicaid |
$4,046.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.76
|
| Rate for Payer: Cash Price |
$5,882.54
|
| Rate for Payer: Cigna Commercial |
$9,765.02
|
| Rate for Payer: First Health Commercial |
$11,176.83
|
| Rate for Payer: Humana Commercial |
$10,000.32
|
| Rate for Payer: Humana KY Medicaid |
$4,046.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,087.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,647.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,127.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,353.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,647.17
|
| Rate for Payer: PHCS Commercial |
$11,294.48
|
| Rate for Payer: United Healthcare All Payer |
$10,353.27
|
|
|
TRIATHLN CR TIB INSRT X3 #8-9M
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLN CR TIB INSRT X3 #8-9M
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 L
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 L
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 R
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #1 R
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 L
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 L
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 R
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 R
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 L
|
Facility
|
OP
|
$7,761.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.04 |
| Max. Negotiated Rate |
$7,451.34 |
| Rate for Payer: Aetna Commercial |
$5,976.59
|
| Rate for Payer: Anthem Medicaid |
$2,669.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.21
|
| Rate for Payer: Cash Price |
$3,880.91
|
| Rate for Payer: Cigna Commercial |
$6,442.30
|
| Rate for Payer: First Health Commercial |
$7,373.72
|
| Rate for Payer: Humana Commercial |
$6,597.54
|
| Rate for Payer: Humana KY Medicaid |
$2,669.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,364.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,722.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.16
|
| Rate for Payer: PHCS Commercial |
$7,451.34
|
| Rate for Payer: United Healthcare All Payer |
$6,830.39
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 L
|
Facility
|
IP
|
$7,761.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.04 |
| Max. Negotiated Rate |
$7,451.34 |
| Rate for Payer: Aetna Commercial |
$5,976.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.21
|
| Rate for Payer: Cash Price |
$3,880.91
|
| Rate for Payer: Cigna Commercial |
$6,442.30
|
| Rate for Payer: First Health Commercial |
$7,373.72
|
| Rate for Payer: Humana Commercial |
$6,597.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,364.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.16
|
| Rate for Payer: PHCS Commercial |
$7,451.34
|
| Rate for Payer: United Healthcare All Payer |
$6,830.39
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 R
|
Facility
|
IP
|
$7,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.86 |
| Max. Negotiated Rate |
$7,125.12 |
| Rate for Payer: Aetna Commercial |
$5,714.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.16
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$6,160.26
|
| Rate for Payer: First Health Commercial |
$7,050.90
|
| Rate for Payer: Humana Commercial |
$6,308.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,300.82
|
| Rate for Payer: PHCS Commercial |
$7,125.12
|
| Rate for Payer: United Healthcare All Payer |
$6,531.36
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 R
|
Facility
|
OP
|
$7,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.86 |
| Max. Negotiated Rate |
$7,125.12 |
| Rate for Payer: Aetna Commercial |
$5,714.94
|
| Rate for Payer: Anthem Medicaid |
$2,552.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.16
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$6,160.26
|
| Rate for Payer: First Health Commercial |
$7,050.90
|
| Rate for Payer: Humana Commercial |
$6,308.70
|
| Rate for Payer: Humana KY Medicaid |
$2,552.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,578.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,603.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,300.82
|
| Rate for Payer: PHCS Commercial |
$7,125.12
|
| Rate for Payer: United Healthcare All Payer |
$6,531.36
|
|
|
TRIATHLN FEM DIS AUG 10MM #4 L
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #4 L
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 L
|
Facility
|
OP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem Medicaid |
$2,707.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Humana KY Medicaid |
$2,707.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,734.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,761.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 L
|
Facility
|
IP
|
$7,871.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.32 |
| Max. Negotiated Rate |
$7,556.81 |
| Rate for Payer: Aetna Commercial |
$6,061.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,139.91
|
| Rate for Payer: Cash Price |
$3,935.84
|
| Rate for Payer: Cigna Commercial |
$6,533.49
|
| Rate for Payer: First Health Commercial |
$7,478.10
|
| Rate for Payer: Humana Commercial |
$6,690.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,454.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,809.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,927.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,903.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.22
|
| Rate for Payer: PHCS Commercial |
$7,556.81
|
| Rate for Payer: United Healthcare All Payer |
$6,927.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 R
|
Facility
|
IP
|
$8,285.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$7,954.16 |
| Rate for Payer: Aetna Commercial |
$6,379.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.75
|
| Rate for Payer: Cash Price |
$4,142.79
|
| Rate for Payer: Cigna Commercial |
$6,877.03
|
| Rate for Payer: First Health Commercial |
$7,871.30
|
| Rate for Payer: Humana Commercial |
$7,042.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,794.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,291.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,214.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.53
|
| Rate for Payer: PHCS Commercial |
$7,954.16
|
| Rate for Payer: United Healthcare All Payer |
$7,291.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 R
|
Facility
|
OP
|
$8,285.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$7,954.16 |
| Rate for Payer: Aetna Commercial |
$6,379.90
|
| Rate for Payer: Anthem Medicaid |
$2,849.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.75
|
| Rate for Payer: Cash Price |
$4,142.79
|
| Rate for Payer: Cigna Commercial |
$6,877.03
|
| Rate for Payer: First Health Commercial |
$7,871.30
|
| Rate for Payer: Humana Commercial |
$7,042.74
|
| Rate for Payer: Humana KY Medicaid |
$2,849.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,794.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,291.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,214.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.53
|
| Rate for Payer: PHCS Commercial |
$7,954.16
|
| Rate for Payer: United Healthcare All Payer |
$7,291.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 L
|
Facility
|
IP
|
$7,570.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.12 |
| Max. Negotiated Rate |
$7,267.38 |
| Rate for Payer: Aetna Commercial |
$5,829.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,904.75
|
| Rate for Payer: Cash Price |
$3,785.09
|
| Rate for Payer: Cigna Commercial |
$6,283.26
|
| Rate for Payer: First Health Commercial |
$7,191.68
|
| Rate for Payer: Humana Commercial |
$6,434.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,207.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,586.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,661.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,677.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.76
|
| Rate for Payer: PHCS Commercial |
$7,267.38
|
| Rate for Payer: United Healthcare All Payer |
$6,661.77
|
|
