|
TRIATHLN TS+ TIB INSRT #5 31MM
|
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 #6 13MM
|
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 #6 13MM
|
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 #6 16MM
|
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 #6 16MM
|
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 #6 19MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIATHLN TS+ TIB INSRT #6 19MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIATHLN TS+ TIB INSRT #6 22MM
|
Facility
|
OP
|
$13,521.67
|
|
|
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 #6 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 #6 25MM
|
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 #6 25MM
|
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 #6 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 #6 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 #6 31MM
|
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 #6 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
|
|
|
TRIATHLN TS+ TIB INSRT #8 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 #8 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
|
|
|
TRIATHLON ASYM PAT A29M*9M
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TRIATHLON ASYM PAT A29M*9M
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TRIATHLON ASYM PAT A32M*10M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON ASYM PAT A32M*10M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON ASYM PAT A35M*10M
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TRIATHLON ASYM PAT A35M*10M
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TRIATHLON ASYM PAT A38M*11M
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TRIATHLON ASYM PAT A38M*11M
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
