|
TRIATHLN TS+ TIB INSRT #1 19MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 22MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 22MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 25MM
|
Facility
|
OP
|
$12,735.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.59 |
| Max. Negotiated Rate |
$12,225.91 |
| Rate for Payer: Aetna Commercial |
$9,806.20
|
| Rate for Payer: Anthem Medicaid |
$4,379.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,933.55
|
| Rate for Payer: Cash Price |
$6,367.66
|
| Rate for Payer: Cigna Commercial |
$10,570.32
|
| Rate for Payer: First Health Commercial |
$12,098.55
|
| Rate for Payer: Humana Commercial |
$10,825.02
|
| Rate for Payer: Humana KY Medicaid |
$4,379.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,424.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,442.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,398.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,820.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,467.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,207.08
|
| Rate for Payer: Ohio Health Group HMO |
$9,551.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,655.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,947.95
|
| Rate for Payer: PHCS Commercial |
$12,225.91
|
| Rate for Payer: United Healthcare All Payer |
$11,207.08
|
|
|
TRIATHLN TS+ TIB INSRT #1 25MM
|
Facility
|
IP
|
$12,735.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.59 |
| Max. Negotiated Rate |
$12,225.91 |
| Rate for Payer: Aetna Commercial |
$9,806.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,933.55
|
| Rate for Payer: Cash Price |
$6,367.66
|
| Rate for Payer: Cigna Commercial |
$10,570.32
|
| Rate for Payer: First Health Commercial |
$12,098.55
|
| Rate for Payer: Humana Commercial |
$10,825.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,442.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,398.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,820.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,207.08
|
| Rate for Payer: Ohio Health Group HMO |
$9,551.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,655.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,947.95
|
| Rate for Payer: PHCS Commercial |
$12,225.91
|
| Rate for Payer: United Healthcare All Payer |
$11,207.08
|
|
|
TRIATHLN TS+ TIB INSRT #1 28MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 28MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 31MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #1 31MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 11MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 11MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 13MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 13MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 16MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 16MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 19MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 19MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLN TS+ TIB INSRT #2 22MM
|
Facility
|
OP
|
$13,267.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.72 |
| Max. Negotiated Rate |
$12,736.38 |
| Rate for Payer: Aetna Commercial |
$10,215.64
|
| Rate for Payer: Anthem Medicaid |
$4,562.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,348.31
|
| Rate for Payer: Cash Price |
$6,633.53
|
| Rate for Payer: Cigna Commercial |
$11,011.66
|
| Rate for Payer: First Health Commercial |
$12,603.71
|
| Rate for Payer: Humana Commercial |
$11,277.00
|
| Rate for Payer: Humana KY Medicaid |
$4,562.54
|
| Rate for Payer: Kentucky WC Medicaid |
$4,608.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,878.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,791.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,980.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,654.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,675.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,950.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,653.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,724.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,112.79
|
| Rate for Payer: PHCS Commercial |
$12,736.38
|
| Rate for Payer: United Healthcare All Payer |
$11,675.01
|
|
|
TRIATHLN TS+ TIB INSRT #2 22MM
|
Facility
|
IP
|
$13,267.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.72 |
| Max. Negotiated Rate |
$12,736.38 |
| Rate for Payer: Aetna Commercial |
$10,215.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,348.31
|
| Rate for Payer: Cash Price |
$6,633.53
|
| Rate for Payer: Cigna Commercial |
$11,011.66
|
| Rate for Payer: First Health Commercial |
$12,603.71
|
| Rate for Payer: Humana Commercial |
$11,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,878.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,791.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,980.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,675.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,950.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,653.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,724.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,112.79
|
| Rate for Payer: PHCS Commercial |
$12,736.38
|
| Rate for Payer: United Healthcare All Payer |
$11,675.01
|
|
|
TRIATHLN TS+ TIB INSRT #2 25MM
|
Facility
|
OP
|
$12,587.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.36 |
| Max. Negotiated Rate |
$12,083.92 |
| Rate for Payer: Aetna Commercial |
$9,692.31
|
| Rate for Payer: Anthem Medicaid |
$4,328.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.19
|
| Rate for Payer: Cash Price |
$6,293.71
|
| Rate for Payer: Cigna Commercial |
$10,447.56
|
| Rate for Payer: First Health Commercial |
$11,958.05
|
| Rate for Payer: Humana Commercial |
$10,699.31
|
| Rate for Payer: Humana KY Medicaid |
$4,328.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,372.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,415.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,076.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.10
|
| Rate for Payer: PHCS Commercial |
$12,083.92
|
| Rate for Payer: United Healthcare All Payer |
$11,076.93
|
|
|
TRIATHLN TS+ TIB INSRT #2 25MM
|
Facility
|
IP
|
$12,587.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.36 |
| Max. Negotiated Rate |
$12,083.92 |
| Rate for Payer: Aetna Commercial |
$9,692.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.19
|
| Rate for Payer: Cash Price |
$6,293.71
|
| Rate for Payer: Cigna Commercial |
$10,447.56
|
| Rate for Payer: First Health Commercial |
$11,958.05
|
| Rate for Payer: Humana Commercial |
$10,699.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,076.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.10
|
| Rate for Payer: PHCS Commercial |
$12,083.92
|
| Rate for Payer: United Healthcare All Payer |
$11,076.93
|
|
|
TRIATHLN TS+ TIB INSRT #2 28MM
|
Facility
|
OP
|
$12,883.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.90 |
| Max. Negotiated Rate |
$12,368.46 |
| Rate for Payer: Aetna Commercial |
$9,920.53
|
| Rate for Payer: Anthem Medicaid |
$4,430.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,049.37
|
| Rate for Payer: Cash Price |
$6,441.90
|
| Rate for Payer: Cigna Commercial |
$10,693.56
|
| Rate for Payer: First Health Commercial |
$12,239.62
|
| Rate for Payer: Humana Commercial |
$10,951.24
|
| Rate for Payer: Humana KY Medicaid |
$4,430.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,475.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,564.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,508.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,519.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,337.75
|
| Rate for Payer: Ohio Health Group HMO |
$9,662.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.98
|
| Rate for Payer: PHCS Commercial |
$12,368.46
|
| Rate for Payer: United Healthcare All Payer |
$11,337.75
|
|
|
TRIATHLN TS+ TIB INSRT #2 28MM
|
Facility
|
IP
|
$12,883.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.90 |
| Max. Negotiated Rate |
$12,368.46 |
| Rate for Payer: Aetna Commercial |
$9,920.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,049.37
|
| Rate for Payer: Cash Price |
$6,441.90
|
| Rate for Payer: Cigna Commercial |
$10,693.56
|
| Rate for Payer: First Health Commercial |
$12,239.62
|
| Rate for Payer: Humana Commercial |
$10,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,564.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,508.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,337.75
|
| Rate for Payer: Ohio Health Group HMO |
$9,662.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.98
|
| Rate for Payer: PHCS Commercial |
$12,368.46
|
| Rate for Payer: United Healthcare All Payer |
$11,337.75
|
|
|
TRIATHLN TS+ TIB INSRT #2 31MM
|
Facility
|
IP
|
$12,587.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.36 |
| Max. Negotiated Rate |
$12,083.92 |
| Rate for Payer: Aetna Commercial |
$9,692.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.19
|
| Rate for Payer: Cash Price |
$6,293.71
|
| Rate for Payer: Cigna Commercial |
$10,447.56
|
| Rate for Payer: First Health Commercial |
$11,958.05
|
| Rate for Payer: Humana Commercial |
$10,699.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,076.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.10
|
| Rate for Payer: PHCS Commercial |
$12,083.92
|
| Rate for Payer: United Healthcare All Payer |
$11,076.93
|
|
|
TRIATHLN TS+ TIB INSRT #2 31MM
|
Facility
|
OP
|
$12,587.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.36 |
| Max. Negotiated Rate |
$12,083.92 |
| Rate for Payer: Aetna Commercial |
$9,692.31
|
| Rate for Payer: Anthem Medicaid |
$4,328.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.19
|
| Rate for Payer: Cash Price |
$6,293.71
|
| Rate for Payer: Cigna Commercial |
$10,447.56
|
| Rate for Payer: First Health Commercial |
$11,958.05
|
| Rate for Payer: Humana Commercial |
$10,699.31
|
| Rate for Payer: Humana KY Medicaid |
$4,328.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,372.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,415.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,076.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.10
|
| Rate for Payer: PHCS Commercial |
$12,083.92
|
| Rate for Payer: United Healthcare All Payer |
$11,076.93
|
|
