Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

TRIATHLON X3 TIB INSRT #6 19MM

Facility

$11,779.68

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,531.36
Max. Negotiated Rate	$11,308.49
Rate for Payer: Aetna Commercial	$9,070.35
Rate for Payer: Anthem Medicaid	$4,051.03
Rate for Payer: Anthem POS/PPO/Traditional	$9,188.15
Rate for Payer: Cash Price	$5,889.84
Rate for Payer: Cigna Commercial	$9,777.13
Rate for Payer: First Health Commercial	$11,190.70
Rate for Payer: Humana Commercial	$10,012.73
Rate for Payer: Humana KY Medicaid	$4,051.03
Rate for Payer: Kentucky WC Medicaid	$4,092.26
Rate for Payer: Medical Mutual Of Ohio HMO	$9,659.34
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$8,693.40
Rate for Payer: Molina Healthcare Benefit Exchange	$3,533.90
Rate for Payer: Molina Healthcare Medicaid	$4,132.31
Rate for Payer: Ohio Health Choice Commercial	$10,366.12
Rate for Payer: Ohio Health Group HMO	$8,834.76
Rate for Payer: Ohio Health Group PPO Differential	$2,355.94
Rate for Payer: Ohio Health Group PPO No Differential	$1,531.36
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,651.70
Rate for Payer: PHCS Commercial	$11,308.49
Rate for Payer: United Healthcare All Payer	$10,366.12

TRIATHLON X3 TIB INSRT #6 19MM

Facility

$11,779.68

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,531.36
Max. Negotiated Rate	$11,308.49
Rate for Payer: Aetna Commercial	$9,070.35
Rate for Payer: Anthem POS/PPO/Traditional	$9,188.15
Rate for Payer: Cash Price	$5,889.84
Rate for Payer: Cigna Commercial	$9,777.13
Rate for Payer: First Health Commercial	$11,190.70
Rate for Payer: Humana Commercial	$10,012.73
Rate for Payer: Medical Mutual Of Ohio HMO	$9,659.34
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$8,693.40
Rate for Payer: Molina Healthcare Benefit Exchange	$3,533.90
Rate for Payer: Ohio Health Choice Commercial	$10,366.12
Rate for Payer: Ohio Health Group HMO	$8,834.76
Rate for Payer: Ohio Health Group PPO Differential	$2,355.94
Rate for Payer: Ohio Health Group PPO No Differential	$1,531.36
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,651.70
Rate for Payer: PHCS Commercial	$11,308.49
Rate for Payer: United Healthcare All Payer	$10,366.12

TRIATHLON X3 TIB INSRT #6 22MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #6 22MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #6 25MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #6 25MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 11MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 11MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 13MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 13MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 16MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 16MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 19MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 19MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 22MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 22MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 25MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #7 25MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 11MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 11MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 13MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 13MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 16MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 16MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem Medicaid	$3,084.27
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Humana KY Medicaid	$3,084.27
Rate for Payer: Kentucky WC Medicaid	$3,115.66
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Molina Healthcare Medicaid	$3,146.15
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

TRIATHLON X3 TIB INSRT #8 19MM

Facility

$8,968.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,165.90
Max. Negotiated Rate	$8,609.76
Rate for Payer: Aetna Commercial	$6,905.74
Rate for Payer: Anthem POS/PPO/Traditional	$6,995.43
Rate for Payer: Cash Price	$4,484.25
Rate for Payer: Cigna Commercial	$7,443.86
Rate for Payer: First Health Commercial	$8,520.08
Rate for Payer: Humana Commercial	$7,623.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,354.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,618.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,690.55
Rate for Payer: Ohio Health Choice Commercial	$7,892.28
Rate for Payer: Ohio Health Group HMO	$6,726.38
Rate for Payer: Ohio Health Group PPO Differential	$1,793.70
Rate for Payer: Ohio Health Group PPO No Differential	$1,165.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,780.24
Rate for Payer: PHCS Commercial	$8,609.76
Rate for Payer: United Healthcare All Payer	$7,892.28

Know your out-of-pocket cost for care.

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