|
TRIATHLN TS+ TIB INSRT #3 11MM
|
Facility
|
IP
|
$12,338.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,603.95 |
| Max. Negotiated Rate |
$11,844.57 |
| Rate for Payer: Aetna Commercial |
$9,500.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.71
|
| Rate for Payer: Cash Price |
$6,169.05
|
| Rate for Payer: Cigna Commercial |
$10,240.61
|
| Rate for Payer: First Health Commercial |
$11,721.19
|
| Rate for Payer: Humana Commercial |
$10,487.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,117.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,105.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,857.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,824.81
|
| Rate for Payer: PHCS Commercial |
$11,844.57
|
| Rate for Payer: United Healthcare All Payer |
$10,857.52
|
|
|
TRIATHLN TS+ TIB INSRT #3 11MM
|
Facility
|
OP
|
$12,338.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,603.95 |
| Max. Negotiated Rate |
$11,844.57 |
| Rate for Payer: Aetna Commercial |
$9,500.33
|
| Rate for Payer: Anthem Medicaid |
$4,243.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.71
|
| Rate for Payer: Cash Price |
$6,169.05
|
| Rate for Payer: Cigna Commercial |
$10,240.61
|
| Rate for Payer: First Health Commercial |
$11,721.19
|
| Rate for Payer: Humana Commercial |
$10,487.38
|
| Rate for Payer: Humana KY Medicaid |
$4,243.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,117.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,105.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,857.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,824.81
|
| Rate for Payer: PHCS Commercial |
$11,844.57
|
| Rate for Payer: United Healthcare All Payer |
$10,857.52
|
|
|
TRIATHLN TS+ TIB INSRT #3 16MM
|
Facility
|
IP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #3 16MM
|
Facility
|
OP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem Medicaid |
$4,665.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Humana KY Medicaid |
$4,665.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,712.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,758.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #3 19MM
|
Facility
|
OP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem Medicaid |
$5,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Humana KY Medicaid |
$5,210.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLN TS+ TIB INSRT #3 19MM
|
Facility
|
IP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLN TS+ TIB INSRT #3 25MM
|
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 #3 25MM
|
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 #3 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 #3 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 #4 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 #4 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 #4 13MM
|
Facility
|
OP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem Medicaid |
$4,665.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Humana KY Medicaid |
$4,665.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,712.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,758.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #4 13MM
|
Facility
|
IP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #4 16MM
|
Facility
|
OP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem Medicaid |
$4,665.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Humana KY Medicaid |
$4,665.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,712.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,758.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #4 16MM
|
Facility
|
IP
|
$13,565.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.58 |
| Max. Negotiated Rate |
$13,023.35 |
| Rate for Payer: Aetna Commercial |
$10,445.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,581.47
|
| Rate for Payer: Cash Price |
$6,783.00
|
| Rate for Payer: Cigna Commercial |
$11,259.77
|
| Rate for Payer: First Health Commercial |
$12,887.69
|
| Rate for Payer: Humana Commercial |
$11,531.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,124.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,011.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,938.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,174.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,205.46
|
| Rate for Payer: PHCS Commercial |
$13,023.35
|
| Rate for Payer: United Healthcare All Payer |
$11,938.07
|
|
|
TRIATHLN TS+ TIB INSRT #4 19MM
|
Facility
|
IP
|
$11,884.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.02 |
| Max. Negotiated Rate |
$11,409.41 |
| Rate for Payer: Aetna Commercial |
$9,151.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,270.14
|
| Rate for Payer: Cash Price |
$5,942.40
|
| Rate for Payer: Cigna Commercial |
$9,864.38
|
| Rate for Payer: First Health Commercial |
$11,290.56
|
| Rate for Payer: Humana Commercial |
$10,102.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,745.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,770.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,565.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,458.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,913.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,376.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,545.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,684.29
|
| Rate for Payer: PHCS Commercial |
$11,409.41
|
| Rate for Payer: United Healthcare All Payer |
$10,458.62
|
|
|
TRIATHLN TS+ TIB INSRT #4 19MM
|
Facility
|
OP
|
$11,884.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.02 |
| Max. Negotiated Rate |
$11,409.41 |
| Rate for Payer: Aetna Commercial |
$9,151.30
|
| Rate for Payer: Anthem Medicaid |
$4,087.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,270.14
|
| Rate for Payer: Cash Price |
$5,942.40
|
| Rate for Payer: Cigna Commercial |
$9,864.38
|
| Rate for Payer: First Health Commercial |
$11,290.56
|
| Rate for Payer: Humana Commercial |
$10,102.08
|
| Rate for Payer: Humana KY Medicaid |
$4,087.18
|
| Rate for Payer: Kentucky WC Medicaid |
$4,128.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,745.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,770.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,565.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,169.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,458.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,913.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,376.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,545.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,684.29
|
| Rate for Payer: PHCS Commercial |
$11,409.41
|
| Rate for Payer: United Healthcare All Payer |
$10,458.62
|
|
|
TRIATHLN TS+ TIB INSRT #4 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 #4 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 #4 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 #4 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 #4 31MM
|
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 #4 31MM
|
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 #5 11MM
|
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
|
|
