|
TRIATHLN TS+ TIB INSRT #5 11MM
|
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 #5 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 #5 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 #5 16MM
|
Facility
|
IP
|
$12,229.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,589.86 |
| Max. Negotiated Rate |
$11,740.54 |
| Rate for Payer: Aetna Commercial |
$9,416.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,539.19
|
| Rate for Payer: Cash Price |
$6,114.86
|
| Rate for Payer: Cigna Commercial |
$10,150.68
|
| Rate for Payer: First Health Commercial |
$11,618.24
|
| Rate for Payer: Humana Commercial |
$10,395.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,028.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,025.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,668.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,762.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,445.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,791.22
|
| Rate for Payer: PHCS Commercial |
$11,740.54
|
| Rate for Payer: United Healthcare All Payer |
$10,762.16
|
|
|
TRIATHLN TS+ TIB INSRT #5 16MM
|
Facility
|
OP
|
$12,229.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,589.86 |
| Max. Negotiated Rate |
$11,740.54 |
| Rate for Payer: Aetna Commercial |
$9,416.89
|
| Rate for Payer: Anthem Medicaid |
$4,205.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,539.19
|
| Rate for Payer: Cash Price |
$6,114.86
|
| Rate for Payer: Cigna Commercial |
$10,150.68
|
| Rate for Payer: First Health Commercial |
$11,618.24
|
| Rate for Payer: Humana Commercial |
$10,395.27
|
| Rate for Payer: Humana KY Medicaid |
$4,205.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,248.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,028.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,025.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,668.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,290.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,762.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,445.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,791.22
|
| Rate for Payer: PHCS Commercial |
$11,740.54
|
| Rate for Payer: United Healthcare All Payer |
$10,762.16
|
|
|
TRIATHLN TS+ TIB INSRT #5 19MM
|
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 #5 19MM
|
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 #5 28MM
|
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 #5 28MM
|
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 #5 31MM
|
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 #5 31MM
|
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 #6 13MM
|
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 #6 13MM
|
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 #6 16MM
|
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 #6 16MM
|
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 #6 19MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIATHLN TS+ TIB INSRT #6 19MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIATHLN TS+ TIB INSRT #6 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 #6 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 #6 25MM
|
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 #6 25MM
|
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 #6 28MM
|
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 #6 28MM
|
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 #6 31MM
|
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 #6 31MM
|
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
|
|
