|
TRIATHLN FEM DIS AUG 10MM #6 L
|
Facility
|
OP
|
$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 Medicaid |
$2,603.39
|
| 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: Humana KY Medicaid |
$2,603.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,629.88
|
| 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: Molina Healthcare Medicaid |
$2,655.62
|
| 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
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 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 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 #7 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 #7 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 #7 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 #7 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 #8 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 #8 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 #8 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 #8 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 15MM #1 L
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 L
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 R
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 R
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 L
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 L
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 R
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 R
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 L
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 L
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 R
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 R
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 L
|
Facility
|
OP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem Medicaid |
$2,566.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Humana KY Medicaid |
$2,566.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 L
|
Facility
|
IP
|
$7,462.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$7,164.36 |
| Rate for Payer: Aetna Commercial |
$5,746.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,821.05
|
| Rate for Payer: Cash Price |
$3,731.44
|
| Rate for Payer: Cigna Commercial |
$6,194.19
|
| Rate for Payer: First Health Commercial |
$7,089.74
|
| Rate for Payer: Humana Commercial |
$6,343.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.49
|
| Rate for Payer: PHCS Commercial |
$7,164.36
|
| Rate for Payer: United Healthcare All Payer |
$6,567.33
|
|
