|
TRIATHLN FEM DIS AUG 10MM #2 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 R
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #2 R
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 L
|
Facility
|
IP
|
$7,961.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.54 |
| Max. Negotiated Rate |
$7,643.34 |
| Rate for Payer: Aetna Commercial |
$6,130.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,210.21
|
| Rate for Payer: Cash Price |
$3,980.91
|
| Rate for Payer: Cigna Commercial |
$6,608.30
|
| Rate for Payer: First Health Commercial |
$7,563.72
|
| Rate for Payer: Humana Commercial |
$6,767.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,875.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,006.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,971.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,369.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,926.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,493.65
|
| Rate for Payer: PHCS Commercial |
$7,643.34
|
| Rate for Payer: United Healthcare All Payer |
$7,006.39
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 L
|
Facility
|
OP
|
$7,961.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.54 |
| Max. Negotiated Rate |
$7,643.34 |
| Rate for Payer: Aetna Commercial |
$6,130.59
|
| Rate for Payer: Anthem Medicaid |
$2,738.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,210.21
|
| Rate for Payer: Cash Price |
$3,980.91
|
| Rate for Payer: Cigna Commercial |
$6,608.30
|
| Rate for Payer: First Health Commercial |
$7,563.72
|
| Rate for Payer: Humana Commercial |
$6,767.54
|
| Rate for Payer: Humana KY Medicaid |
$2,738.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,765.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,875.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,388.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,006.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,971.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,369.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,926.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,493.65
|
| Rate for Payer: PHCS Commercial |
$7,643.34
|
| Rate for Payer: United Healthcare All Payer |
$7,006.39
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 R
|
Facility
|
IP
|
$7,622.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,286.60 |
| Max. Negotiated Rate |
$7,317.12 |
| Rate for Payer: Aetna Commercial |
$5,868.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,945.16
|
| Rate for Payer: Cash Price |
$3,811.00
|
| Rate for Payer: Cigna Commercial |
$6,326.26
|
| Rate for Payer: First Health Commercial |
$7,240.90
|
| Rate for Payer: Humana Commercial |
$6,478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,250.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,707.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,716.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.18
|
| Rate for Payer: PHCS Commercial |
$7,317.12
|
| Rate for Payer: United Healthcare All Payer |
$6,707.36
|
|
|
TRIATHLN FEM DIS AUG 10MM #3 R
|
Facility
|
OP
|
$7,622.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,286.60 |
| Max. Negotiated Rate |
$7,317.12 |
| Rate for Payer: Aetna Commercial |
$5,868.94
|
| Rate for Payer: Anthem Medicaid |
$2,621.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,945.16
|
| Rate for Payer: Cash Price |
$3,811.00
|
| Rate for Payer: Cigna Commercial |
$6,326.26
|
| Rate for Payer: First Health Commercial |
$7,240.90
|
| Rate for Payer: Humana Commercial |
$6,478.70
|
| Rate for Payer: Humana KY Medicaid |
$2,621.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,647.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,250.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,673.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,707.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,716.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.18
|
| Rate for Payer: PHCS Commercial |
$7,317.12
|
| Rate for Payer: United Healthcare All Payer |
$6,707.36
|
|
|
TRIATHLN FEM DIS AUG 10MM #4 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #4 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 R
|
Facility
|
OP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem Medicaid |
$2,918.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Humana KY Medicaid |
$2,918.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #5 R
|
Facility
|
IP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 L
|
Facility
|
IP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 L
|
Facility
|
OP
|
$7,770.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.06 |
| Max. Negotiated Rate |
$7,459.38 |
| Rate for Payer: Aetna Commercial |
$5,983.05
|
| Rate for Payer: Anthem Medicaid |
$2,672.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,060.75
|
| Rate for Payer: Cash Price |
$3,885.09
|
| Rate for Payer: Cigna Commercial |
$6,449.26
|
| Rate for Payer: First Health Commercial |
$7,381.68
|
| Rate for Payer: Humana Commercial |
$6,604.66
|
| Rate for Payer: Humana KY Medicaid |
$2,672.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,699.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,371.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,734.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,725.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,837.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,827.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,760.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,361.43
|
| Rate for Payer: PHCS Commercial |
$7,459.38
|
| Rate for Payer: United Healthcare All Payer |
$6,837.77
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 R
|
Facility
|
OP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem Medicaid |
$2,918.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Humana KY Medicaid |
$2,918.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #6 R
|
Facility
|
IP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #7 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #7 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #7 R
|
Facility
|
OP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem Medicaid |
$2,918.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Humana KY Medicaid |
$2,918.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #7 R
|
Facility
|
IP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
|
TRIATHLN FEM DIS AUG 10MM #8 L
|
Facility
|
IP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #8 L
|
Facility
|
OP
|
$8,071.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,421.50 |
| Max. Negotiated Rate |
$7,748.81 |
| Rate for Payer: Aetna Commercial |
$6,215.19
|
| Rate for Payer: Anthem Medicaid |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,295.91
|
| Rate for Payer: Cash Price |
$4,035.84
|
| Rate for Payer: Cigna Commercial |
$6,699.49
|
| Rate for Payer: First Health Commercial |
$7,668.10
|
| Rate for Payer: Humana Commercial |
$6,860.93
|
| Rate for Payer: Humana KY Medicaid |
$2,775.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,804.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,618.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,956.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,421.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,831.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,103.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,457.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,022.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,569.46
|
| Rate for Payer: PHCS Commercial |
$7,748.81
|
| Rate for Payer: United Healthcare All Payer |
$7,103.08
|
|
|
TRIATHLN FEM DIS AUG 10MM #8 R
|
Facility
|
IP
|
$8,485.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.67 |
| Max. Negotiated Rate |
$8,146.16 |
| Rate for Payer: Aetna Commercial |
$6,533.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Cash Price |
$4,242.79
|
| Rate for Payer: Cigna Commercial |
$7,043.03
|
| Rate for Payer: First Health Commercial |
$8,061.30
|
| Rate for Payer: Humana Commercial |
$7,212.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.05
|
| Rate for Payer: PHCS Commercial |
$8,146.16
|
| Rate for Payer: United Healthcare All Payer |
$7,467.31
|
|
