|
TRIATHLN TS+ TIB INSRT #4 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 #4 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 #4 13MM
|
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 #4 13MM
|
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 #4 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 #4 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 #4 19MM
|
Facility
|
OP
|
$12,131.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,639.55 |
| Max. Negotiated Rate |
$11,646.57 |
| Rate for Payer: Aetna Commercial |
$9,341.52
|
| Rate for Payer: Anthem Medicaid |
$4,172.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,462.84
|
| Rate for Payer: Cash Price |
$6,065.92
|
| Rate for Payer: Cigna Commercial |
$10,069.43
|
| Rate for Payer: First Health Commercial |
$11,525.25
|
| Rate for Payer: Humana Commercial |
$10,312.06
|
| Rate for Payer: Humana KY Medicaid |
$4,172.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,214.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,948.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,953.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,639.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,255.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,676.02
|
| Rate for Payer: Ohio Health Group HMO |
$9,098.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,705.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,554.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,370.97
|
| Rate for Payer: PHCS Commercial |
$11,646.57
|
| Rate for Payer: United Healthcare All Payer |
$10,676.02
|
|
|
TRIATHLN TS+ TIB INSRT #4 19MM
|
Facility
|
IP
|
$12,131.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,639.55 |
| Max. Negotiated Rate |
$11,646.57 |
| Rate for Payer: Aetna Commercial |
$9,341.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,462.84
|
| Rate for Payer: Cash Price |
$6,065.92
|
| Rate for Payer: Cigna Commercial |
$10,069.43
|
| Rate for Payer: First Health Commercial |
$11,525.25
|
| Rate for Payer: Humana Commercial |
$10,312.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,948.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,953.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,676.02
|
| Rate for Payer: Ohio Health Group HMO |
$9,098.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,705.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,554.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,370.97
|
| Rate for Payer: PHCS Commercial |
$11,646.57
|
| Rate for Payer: United Healthcare All Payer |
$10,676.02
|
|
|
TRIATHLN TS+ TIB INSRT #4 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 #4 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 #4 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 #4 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 #4 31MM
|
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 #4 31MM
|
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 #5 11MM
|
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 #5 11MM
|
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 #5 13MM
|
Facility
|
OP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem Medicaid |
$4,297.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Humana KY Medicaid |
$4,297.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLN TS+ TIB INSRT #5 13MM
|
Facility
|
IP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLN TS+ TIB INSRT #5 16MM
|
Facility
|
OP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem Medicaid |
$4,297.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Humana KY Medicaid |
$4,297.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLN TS+ TIB INSRT #5 16MM
|
Facility
|
IP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLN TS+ TIB INSRT #5 19MM
|
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 #5 19MM
|
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 #5 28MM
|
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 #5 28MM
|
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 #5 31MM
|
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
|
|
