|
TRIATHLN FEM DIS AUG 10MM #8 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 15MM #1 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #1 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #2 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #3 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #4 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #5 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #5 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #5 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #5 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #6 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #6 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #6 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #6 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
