|
TRIATHLN TS+ TIB INSRT #2 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 #2 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 #2 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 #2 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 #2 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 #2 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 #2 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 #2 22MM
|
Facility
|
OP
|
$13,521.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,056.50 |
| Max. Negotiated Rate |
$12,980.80 |
| Rate for Payer: Aetna Commercial |
$10,411.69
|
| Rate for Payer: Anthem Medicaid |
$4,650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,546.90
|
| Rate for Payer: Cash Price |
$6,760.83
|
| Rate for Payer: Cigna Commercial |
$11,222.99
|
| Rate for Payer: First Health Commercial |
$12,845.59
|
| Rate for Payer: Humana Commercial |
$11,493.42
|
| Rate for Payer: Humana KY Medicaid |
$4,650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,697.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,087.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,978.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,743.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,817.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,763.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,329.95
|
| Rate for Payer: PHCS Commercial |
$12,980.80
|
| Rate for Payer: United Healthcare All Payer |
$11,899.07
|
|
|
TRIATHLN TS+ TIB INSRT #2 22MM
|
Facility
|
IP
|
$13,521.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,056.50 |
| Max. Negotiated Rate |
$12,980.80 |
| Rate for Payer: Aetna Commercial |
$10,411.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,546.90
|
| Rate for Payer: Cash Price |
$6,760.83
|
| Rate for Payer: Cigna Commercial |
$11,222.99
|
| Rate for Payer: First Health Commercial |
$12,845.59
|
| Rate for Payer: Humana Commercial |
$11,493.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,087.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,978.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,817.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,763.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,329.95
|
| Rate for Payer: PHCS Commercial |
$12,980.80
|
| Rate for Payer: United Healthcare All Payer |
$11,899.07
|
|
|
TRIATHLN TS+ TIB INSRT #2 25MM
|
Facility
|
IP
|
$12,838.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,851.50 |
| Max. Negotiated Rate |
$12,324.79 |
| Rate for Payer: Aetna Commercial |
$9,885.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,013.89
|
| Rate for Payer: Cash Price |
$6,419.16
|
| Rate for Payer: Cigna Commercial |
$10,655.81
|
| Rate for Payer: First Health Commercial |
$12,196.40
|
| Rate for Payer: Humana Commercial |
$10,912.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,527.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,474.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,297.72
|
| Rate for Payer: Ohio Health Group HMO |
$9,628.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,270.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,169.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,858.44
|
| Rate for Payer: PHCS Commercial |
$12,324.79
|
| Rate for Payer: United Healthcare All Payer |
$11,297.72
|
|
|
TRIATHLN TS+ TIB INSRT #2 25MM
|
Facility
|
OP
|
$12,838.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,851.50 |
| Max. Negotiated Rate |
$12,324.79 |
| Rate for Payer: Aetna Commercial |
$9,885.51
|
| Rate for Payer: Anthem Medicaid |
$4,415.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,013.89
|
| Rate for Payer: Cash Price |
$6,419.16
|
| Rate for Payer: Cigna Commercial |
$10,655.81
|
| Rate for Payer: First Health Commercial |
$12,196.40
|
| Rate for Payer: Humana Commercial |
$10,912.57
|
| Rate for Payer: Humana KY Medicaid |
$4,415.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,527.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,474.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,503.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,297.72
|
| Rate for Payer: Ohio Health Group HMO |
$9,628.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,270.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,169.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,858.44
|
| Rate for Payer: PHCS Commercial |
$12,324.79
|
| Rate for Payer: United Healthcare All Payer |
$11,297.72
|
|
|
TRIATHLN TS+ TIB INSRT #2 28MM
|
Facility
|
OP
|
$13,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.90 |
| Max. Negotiated Rate |
$12,610.87 |
| Rate for Payer: Aetna Commercial |
$10,114.97
|
| Rate for Payer: Anthem Medicaid |
$4,517.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.33
|
| Rate for Payer: Cash Price |
$6,568.16
|
| Rate for Payer: Cigna Commercial |
$10,903.15
|
| Rate for Payer: First Health Commercial |
$12,479.50
|
| Rate for Payer: Humana Commercial |
$11,165.87
|
| Rate for Payer: Humana KY Medicaid |
$4,517.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,771.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,559.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,428.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.06
|
| Rate for Payer: PHCS Commercial |
$12,610.87
|
| Rate for Payer: United Healthcare All Payer |
$11,559.96
|
|
|
TRIATHLN TS+ TIB INSRT #2 28MM
|
Facility
|
IP
|
$13,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.90 |
| Max. Negotiated Rate |
$12,610.87 |
| Rate for Payer: Aetna Commercial |
$10,114.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.33
|
| Rate for Payer: Cash Price |
$6,568.16
|
| Rate for Payer: Cigna Commercial |
$10,903.15
|
| Rate for Payer: First Health Commercial |
$12,479.50
|
| Rate for Payer: Humana Commercial |
$11,165.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,771.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,559.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,428.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.06
|
| Rate for Payer: PHCS Commercial |
$12,610.87
|
| Rate for Payer: United Healthcare All Payer |
$11,559.96
|
|
|
TRIATHLN TS+ TIB INSRT #2 31MM
|
Facility
|
OP
|
$12,838.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,851.50 |
| Max. Negotiated Rate |
$12,324.79 |
| Rate for Payer: Aetna Commercial |
$9,885.51
|
| Rate for Payer: Anthem Medicaid |
$4,415.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,013.89
|
| Rate for Payer: Cash Price |
$6,419.16
|
| Rate for Payer: Cigna Commercial |
$10,655.81
|
| Rate for Payer: First Health Commercial |
$12,196.40
|
| Rate for Payer: Humana Commercial |
$10,912.57
|
| Rate for Payer: Humana KY Medicaid |
$4,415.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,527.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,474.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,503.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,297.72
|
| Rate for Payer: Ohio Health Group HMO |
$9,628.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,270.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,169.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,858.44
|
| Rate for Payer: PHCS Commercial |
$12,324.79
|
| Rate for Payer: United Healthcare All Payer |
$11,297.72
|
|
|
TRIATHLN TS+ TIB INSRT #2 31MM
|
Facility
|
IP
|
$12,838.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,851.50 |
| Max. Negotiated Rate |
$12,324.79 |
| Rate for Payer: Aetna Commercial |
$9,885.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,013.89
|
| Rate for Payer: Cash Price |
$6,419.16
|
| Rate for Payer: Cigna Commercial |
$10,655.81
|
| Rate for Payer: First Health Commercial |
$12,196.40
|
| Rate for Payer: Humana Commercial |
$10,912.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,527.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,474.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,297.72
|
| Rate for Payer: Ohio Health Group HMO |
$9,628.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,270.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,169.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,858.44
|
| Rate for Payer: PHCS Commercial |
$12,324.79
|
| Rate for Payer: United Healthcare All Payer |
$11,297.72
|
|
|
TRIATHLN TS+ TIB INSRT #3 11MM
|
Facility
|
IP
|
$12,587.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.29 |
| Max. Negotiated Rate |
$12,084.12 |
| Rate for Payer: Aetna Commercial |
$9,692.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.34
|
| Rate for Payer: Cash Price |
$6,293.81
|
| Rate for Payer: Cigna Commercial |
$10,447.72
|
| Rate for Payer: First Health Commercial |
$11,958.24
|
| Rate for Payer: Humana Commercial |
$10,699.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,077.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,070.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,951.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,685.46
|
| Rate for Payer: PHCS Commercial |
$12,084.12
|
| Rate for Payer: United Healthcare All Payer |
$11,077.11
|
|
|
TRIATHLN TS+ TIB INSRT #3 11MM
|
Facility
|
OP
|
$12,587.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.29 |
| Max. Negotiated Rate |
$12,084.12 |
| Rate for Payer: Aetna Commercial |
$9,692.47
|
| Rate for Payer: Anthem Medicaid |
$4,328.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,818.34
|
| Rate for Payer: Cash Price |
$6,293.81
|
| Rate for Payer: Cigna Commercial |
$10,447.72
|
| Rate for Payer: First Health Commercial |
$11,958.24
|
| Rate for Payer: Humana Commercial |
$10,699.48
|
| Rate for Payer: Humana KY Medicaid |
$4,328.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,372.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,321.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,289.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,415.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,077.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,440.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,070.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,951.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,685.46
|
| Rate for Payer: PHCS Commercial |
$12,084.12
|
| Rate for Payer: United Healthcare All Payer |
$11,077.11
|
|
|
TRIATHLN TS+ TIB INSRT #3 16MM
|
Facility
|
IP
|
$13,822.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,146.67 |
| Max. Negotiated Rate |
$13,269.35 |
| Rate for Payer: Aetna Commercial |
$10,643.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,781.35
|
| Rate for Payer: Cash Price |
$6,911.12
|
| Rate for Payer: Cigna Commercial |
$11,472.46
|
| Rate for Payer: First Health Commercial |
$13,131.13
|
| Rate for Payer: Humana Commercial |
$11,748.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,334.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,200.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,146.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,163.57
|
| Rate for Payer: Ohio Health Group HMO |
$10,366.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,537.35
|
| Rate for Payer: PHCS Commercial |
$13,269.35
|
| Rate for Payer: United Healthcare All Payer |
$12,163.57
|
|
|
TRIATHLN TS+ TIB INSRT #3 16MM
|
Facility
|
OP
|
$13,822.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,146.67 |
| Max. Negotiated Rate |
$13,269.35 |
| Rate for Payer: Aetna Commercial |
$10,643.12
|
| Rate for Payer: Anthem Medicaid |
$4,753.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,781.35
|
| Rate for Payer: Cash Price |
$6,911.12
|
| Rate for Payer: Cigna Commercial |
$11,472.46
|
| Rate for Payer: First Health Commercial |
$13,131.13
|
| Rate for Payer: Humana Commercial |
$11,748.90
|
| Rate for Payer: Humana KY Medicaid |
$4,753.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,801.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,334.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,200.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,146.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,848.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,163.57
|
| Rate for Payer: Ohio Health Group HMO |
$10,366.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,537.35
|
| Rate for Payer: PHCS Commercial |
$13,269.35
|
| Rate for Payer: United Healthcare All Payer |
$12,163.57
|
|
|
TRIATHLN TS+ TIB INSRT #3 19MM
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLN TS+ TIB INSRT #3 19MM
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLN TS+ TIB INSRT #3 25MM
|
Facility
|
IP
|
$13,521.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,056.50 |
| Max. Negotiated Rate |
$12,980.80 |
| Rate for Payer: Aetna Commercial |
$10,411.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,546.90
|
| Rate for Payer: Cash Price |
$6,760.83
|
| Rate for Payer: Cigna Commercial |
$11,222.99
|
| Rate for Payer: First Health Commercial |
$12,845.59
|
| Rate for Payer: Humana Commercial |
$11,493.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,087.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,978.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,817.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,763.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,329.95
|
| Rate for Payer: PHCS Commercial |
$12,980.80
|
| Rate for Payer: United Healthcare All Payer |
$11,899.07
|
|
|
TRIATHLN TS+ TIB INSRT #3 25MM
|
Facility
|
OP
|
$13,521.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,056.50 |
| Max. Negotiated Rate |
$12,980.80 |
| Rate for Payer: Aetna Commercial |
$10,411.69
|
| Rate for Payer: Anthem Medicaid |
$4,650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,546.90
|
| Rate for Payer: Cash Price |
$6,760.83
|
| Rate for Payer: Cigna Commercial |
$11,222.99
|
| Rate for Payer: First Health Commercial |
$12,845.59
|
| Rate for Payer: Humana Commercial |
$11,493.42
|
| Rate for Payer: Humana KY Medicaid |
$4,650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,697.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,087.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,978.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,743.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$10,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,817.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,763.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,329.95
|
| Rate for Payer: PHCS Commercial |
$12,980.80
|
| Rate for Payer: United Healthcare All Payer |
$11,899.07
|
|
|
TRIATHLN TS+ TIB INSRT #3 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 #3 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
|
|
