|
TRIATHLON FEM DIS AUG 5MM #1 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #1 R
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 L
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 L
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #2 R
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 L
|
Facility
|
IP
|
$7,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.43 |
| Max. Negotiated Rate |
$7,321.34 |
| Rate for Payer: Aetna Commercial |
$5,872.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,948.59
|
| Rate for Payer: Cash Price |
$3,813.20
|
| Rate for Payer: Cigna Commercial |
$6,329.91
|
| Rate for Payer: First Health Commercial |
$7,245.08
|
| Rate for Payer: Humana Commercial |
$6,482.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,253.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.18
|
| Rate for Payer: PHCS Commercial |
$7,321.34
|
| Rate for Payer: United Healthcare All Payer |
$6,711.23
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 L
|
Facility
|
OP
|
$7,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.43 |
| Max. Negotiated Rate |
$7,321.34 |
| Rate for Payer: Aetna Commercial |
$5,872.33
|
| Rate for Payer: Anthem Medicaid |
$2,622.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,948.59
|
| Rate for Payer: Cash Price |
$3,813.20
|
| Rate for Payer: Cigna Commercial |
$6,329.91
|
| Rate for Payer: First Health Commercial |
$7,245.08
|
| Rate for Payer: Humana Commercial |
$6,482.44
|
| Rate for Payer: Humana KY Medicaid |
$2,622.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,649.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,253.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.18
|
| Rate for Payer: PHCS Commercial |
$7,321.34
|
| Rate for Payer: United Healthcare All Payer |
$6,711.23
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #3 R
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 L
|
Facility
|
IP
|
$7,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.43 |
| Max. Negotiated Rate |
$7,321.34 |
| Rate for Payer: Aetna Commercial |
$5,872.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,948.59
|
| Rate for Payer: Cash Price |
$3,813.20
|
| Rate for Payer: Cigna Commercial |
$6,329.91
|
| Rate for Payer: First Health Commercial |
$7,245.08
|
| Rate for Payer: Humana Commercial |
$6,482.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,253.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.18
|
| Rate for Payer: PHCS Commercial |
$7,321.34
|
| Rate for Payer: United Healthcare All Payer |
$6,711.23
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 L
|
Facility
|
OP
|
$7,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.43 |
| Max. Negotiated Rate |
$7,321.34 |
| Rate for Payer: Aetna Commercial |
$5,872.33
|
| Rate for Payer: Anthem Medicaid |
$2,622.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,948.59
|
| Rate for Payer: Cash Price |
$3,813.20
|
| Rate for Payer: Cigna Commercial |
$6,329.91
|
| Rate for Payer: First Health Commercial |
$7,245.08
|
| Rate for Payer: Humana Commercial |
$6,482.44
|
| Rate for Payer: Humana KY Medicaid |
$2,622.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,649.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,253.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,287.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,711.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,525.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,364.18
|
| Rate for Payer: PHCS Commercial |
$7,321.34
|
| Rate for Payer: United Healthcare All Payer |
$6,711.23
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 R
|
Facility
|
OP
|
$8,022.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.91 |
| Max. Negotiated Rate |
$7,701.52 |
| Rate for Payer: Aetna Commercial |
$6,177.26
|
| Rate for Payer: Anthem Medicaid |
$2,758.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.49
|
| Rate for Payer: Cash Price |
$4,011.21
|
| Rate for Payer: Cigna Commercial |
$6,658.61
|
| Rate for Payer: First Health Commercial |
$7,621.30
|
| Rate for Payer: Humana Commercial |
$6,819.06
|
| Rate for Payer: Humana KY Medicaid |
$2,758.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,604.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.95
|
| Rate for Payer: PHCS Commercial |
$7,701.52
|
| Rate for Payer: United Healthcare All Payer |
$7,059.73
|
|
|
TRIATHLON FEM DIS AUG 5MM #4 R
|
Facility
|
IP
|
$8,022.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.91 |
| Max. Negotiated Rate |
$7,701.52 |
| Rate for Payer: Aetna Commercial |
$6,177.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.49
|
| Rate for Payer: Cash Price |
$4,011.21
|
| Rate for Payer: Cigna Commercial |
$6,658.61
|
| Rate for Payer: First Health Commercial |
$7,621.30
|
| Rate for Payer: Humana Commercial |
$6,819.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,604.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.95
|
| Rate for Payer: PHCS Commercial |
$7,701.52
|
| Rate for Payer: United Healthcare All Payer |
$7,059.73
|
|
|
TRIATHLON FEM DIS AUG 5MM #5 L
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #5 L
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #5 R
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #5 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #6 L
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #6 L
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #6 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #6 R
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #7 L
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #7 L
|
Facility
|
OP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem Medicaid |
$2,586.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Humana KY Medicaid |
$2,586.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,613.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,638.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
|
TRIATHLON FEM DIS AUG 5MM #7 R
|
Facility
|
IP
|
$7,521.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.81 |
| Max. Negotiated Rate |
$7,220.77 |
| Rate for Payer: Aetna Commercial |
$5,791.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,866.88
|
| Rate for Payer: Cash Price |
$3,760.82
|
| Rate for Payer: Cigna Commercial |
$6,242.96
|
| Rate for Payer: First Health Commercial |
$7,145.56
|
| Rate for Payer: Humana Commercial |
$6,393.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,550.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,256.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,619.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,641.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,504.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$977.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,331.71
|
| Rate for Payer: PHCS Commercial |
$7,220.77
|
| Rate for Payer: United Healthcare All Payer |
$6,619.04
|
|
