|
TRIATHLN FEM DIS AUG 15MM #4 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 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 #5 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 #5 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 #5 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 #5 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 #6 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 #6 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 #6 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 #6 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 #7 L
|
Facility
|
OP
|
$7,725.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.34 |
| Max. Negotiated Rate |
$7,416.65 |
| Rate for Payer: Aetna Commercial |
$5,948.77
|
| Rate for Payer: Anthem Medicaid |
$2,656.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.03
|
| Rate for Payer: Cash Price |
$3,862.84
|
| Rate for Payer: Cigna Commercial |
$6,412.31
|
| Rate for Payer: First Health Commercial |
$7,339.40
|
| Rate for Payer: Humana Commercial |
$6,566.83
|
| Rate for Payer: Humana KY Medicaid |
$2,656.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,683.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,701.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,317.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,798.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,794.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.96
|
| Rate for Payer: PHCS Commercial |
$7,416.65
|
| Rate for Payer: United Healthcare All Payer |
$6,798.60
|
|
|
TRIATHLN FEM DIS AUG 15MM #7 L
|
Facility
|
IP
|
$7,725.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.34 |
| Max. Negotiated Rate |
$7,416.65 |
| Rate for Payer: Aetna Commercial |
$5,948.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.03
|
| Rate for Payer: Cash Price |
$3,862.84
|
| Rate for Payer: Cigna Commercial |
$6,412.31
|
| Rate for Payer: First Health Commercial |
$7,339.40
|
| Rate for Payer: Humana Commercial |
$6,566.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,701.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,317.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,798.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,794.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.96
|
| Rate for Payer: PHCS Commercial |
$7,416.65
|
| Rate for Payer: United Healthcare All Payer |
$6,798.60
|
|
|
TRIATHLN FEM DIS AUG 15MM #7 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 #7 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 #8 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 #8 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 #8 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 #8 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 TS+ TIB INSRT #1 11MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 11MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 13MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 13MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 16MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 16MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 19MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
