|
TRIATHLN FEM DIS AUG 15MM #7 L
|
Facility
|
OP
|
$7,925.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,377.70 |
| Max. Negotiated Rate |
$7,608.65 |
| Rate for Payer: Aetna Commercial |
$6,102.77
|
| Rate for Payer: Anthem Medicaid |
$2,725.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,182.03
|
| Rate for Payer: Cash Price |
$3,962.84
|
| Rate for Payer: Cigna Commercial |
$6,578.31
|
| Rate for Payer: First Health Commercial |
$7,529.40
|
| Rate for Payer: Humana Commercial |
$6,736.83
|
| Rate for Payer: Humana KY Medicaid |
$2,725.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,753.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,499.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,849.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,377.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,974.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,944.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,340.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,895.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,468.72
|
| Rate for Payer: PHCS Commercial |
$7,608.65
|
| Rate for Payer: United Healthcare All Payer |
$6,974.60
|
|
|
TRIATHLN FEM DIS AUG 15MM #7 L
|
Facility
|
IP
|
$7,925.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,377.70 |
| Max. Negotiated Rate |
$7,608.65 |
| Rate for Payer: Aetna Commercial |
$6,102.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,182.03
|
| Rate for Payer: Cash Price |
$3,962.84
|
| Rate for Payer: Cigna Commercial |
$6,578.31
|
| Rate for Payer: First Health Commercial |
$7,529.40
|
| Rate for Payer: Humana Commercial |
$6,736.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,499.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,849.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,377.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,974.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,944.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,340.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,895.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,468.72
|
| Rate for Payer: PHCS Commercial |
$7,608.65
|
| Rate for Payer: United Healthcare All Payer |
$6,974.60
|
|
|
TRIATHLN FEM DIS AUG 15MM #7 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #7 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #8 L
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #8 L
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #8 R
|
Facility
|
IP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN FEM DIS AUG 15MM #8 R
|
Facility
|
OP
|
$7,662.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.86 |
| Max. Negotiated Rate |
$7,356.36 |
| Rate for Payer: Aetna Commercial |
$5,900.42
|
| Rate for Payer: Anthem Medicaid |
$2,635.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,977.05
|
| Rate for Payer: Cash Price |
$3,831.44
|
| Rate for Payer: Cigna Commercial |
$6,360.19
|
| Rate for Payer: First Health Commercial |
$7,279.74
|
| Rate for Payer: Humana Commercial |
$6,513.45
|
| Rate for Payer: Humana KY Medicaid |
$2,635.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,283.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,655.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,743.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,130.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,666.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,287.39
|
| Rate for Payer: PHCS Commercial |
$7,356.36
|
| Rate for Payer: United Healthcare All Payer |
$6,743.33
|
|
|
TRIATHLN TS+ TIB INSRT #1 11MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 11MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 13MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 13MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 16MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 16MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 19MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 19MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 22MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 22MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 25MM
|
Facility
|
IP
|
$12,987.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,896.11 |
| Max. Negotiated Rate |
$12,467.54 |
| Rate for Payer: Aetna Commercial |
$10,000.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,129.88
|
| Rate for Payer: Cash Price |
$6,493.51
|
| Rate for Payer: Cigna Commercial |
$10,779.23
|
| Rate for Payer: First Health Commercial |
$12,337.67
|
| Rate for Payer: Humana Commercial |
$11,038.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,649.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,584.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,896.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,428.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,740.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,389.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,298.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,961.04
|
| Rate for Payer: PHCS Commercial |
$12,467.54
|
| Rate for Payer: United Healthcare All Payer |
$11,428.58
|
|
|
TRIATHLN TS+ TIB INSRT #1 25MM
|
Facility
|
OP
|
$12,987.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,896.11 |
| Max. Negotiated Rate |
$12,467.54 |
| Rate for Payer: Aetna Commercial |
$10,000.01
|
| Rate for Payer: Anthem Medicaid |
$4,466.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,129.88
|
| Rate for Payer: Cash Price |
$6,493.51
|
| Rate for Payer: Cigna Commercial |
$10,779.23
|
| Rate for Payer: First Health Commercial |
$12,337.67
|
| Rate for Payer: Humana Commercial |
$11,038.97
|
| Rate for Payer: Humana KY Medicaid |
$4,466.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,511.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,649.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,584.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,896.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,555.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,428.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,740.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,389.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,298.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,961.04
|
| Rate for Payer: PHCS Commercial |
$12,467.54
|
| Rate for Payer: United Healthcare All Payer |
$11,428.58
|
|
|
TRIATHLN TS+ TIB INSRT #1 28MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 28MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 31MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #1 31MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLN TS+ TIB INSRT #2 11MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
