|
TRIATHLON CR FEM COMP BEAD 8R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRIATHLON CR TB INSRT X3 #2-9M
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TB INSRT X3 #2-9M
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TIB INRT X3 #3-11
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TIB INRT X3 #3-11
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TIB INRT X3 #4-11
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TIB INRT X3 #4-11
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
TRIATHLON CR TIB INSERT #1-9MM
|
Facility
|
IP
|
$8,616.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.16 |
| Max. Negotiated Rate |
$8,271.97 |
| Rate for Payer: Aetna Commercial |
$6,634.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.98
|
| Rate for Payer: Cash Price |
$4,308.32
|
| Rate for Payer: Cigna Commercial |
$7,151.81
|
| Rate for Payer: First Health Commercial |
$8,185.81
|
| Rate for Payer: Humana Commercial |
$7,324.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,065.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,359.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,582.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,462.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$8,271.97
|
| Rate for Payer: United Healthcare All Payer |
$7,582.64
|
|
|
TRIATHLON CR TIB INSERT #1-9MM
|
Facility
|
OP
|
$8,616.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.16 |
| Max. Negotiated Rate |
$8,271.97 |
| Rate for Payer: Aetna Commercial |
$6,634.81
|
| Rate for Payer: Anthem Medicaid |
$2,963.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.98
|
| Rate for Payer: Cash Price |
$4,308.32
|
| Rate for Payer: Cigna Commercial |
$7,151.81
|
| Rate for Payer: First Health Commercial |
$8,185.81
|
| Rate for Payer: Humana Commercial |
$7,324.14
|
| Rate for Payer: Humana KY Medicaid |
$2,963.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,065.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,359.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,582.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,462.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$8,271.97
|
| Rate for Payer: United Healthcare All Payer |
$7,582.64
|
|
|
TRIATHLON CR TIB INSERT #2-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #2-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #3-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #3-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #4-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #4-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #5-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #5-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #6-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #6-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #7-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #7-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #8-9MM
|
Facility
|
IP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSERT #8-9MM
|
Facility
|
OP
|
$8,380.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.42 |
| Max. Negotiated Rate |
$8,044.92 |
| Rate for Payer: Aetna Commercial |
$6,452.69
|
| Rate for Payer: Anthem Medicaid |
$2,881.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,536.49
|
| Rate for Payer: Cash Price |
$4,190.06
|
| Rate for Payer: Cigna Commercial |
$6,955.50
|
| Rate for Payer: First Health Commercial |
$7,961.11
|
| Rate for Payer: Humana Commercial |
$7,123.10
|
| Rate for Payer: Humana KY Medicaid |
$2,881.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,871.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,184.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,374.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,285.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,597.84
|
| Rate for Payer: PHCS Commercial |
$8,044.92
|
| Rate for Payer: United Healthcare All Payer |
$7,374.51
|
|
|
TRIATHLON CR TIB INSRT #1-11MM
|
Facility
|
IP
|
$8,616.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.14 |
| Max. Negotiated Rate |
$8,271.83 |
| Rate for Payer: Aetna Commercial |
$6,634.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.86
|
| Rate for Payer: Cash Price |
$4,308.25
|
| Rate for Payer: Cigna Commercial |
$7,151.69
|
| Rate for Payer: First Health Commercial |
$8,185.67
|
| Rate for Payer: Humana Commercial |
$7,324.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,065.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,582.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,462.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.11
|
| Rate for Payer: PHCS Commercial |
$8,271.83
|
| Rate for Payer: United Healthcare All Payer |
$7,582.51
|
|
|
TRIATHLON CR TIB INSRT #1-11MM
|
Facility
|
OP
|
$8,616.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.14 |
| Max. Negotiated Rate |
$8,271.83 |
| Rate for Payer: Aetna Commercial |
$6,634.70
|
| Rate for Payer: Anthem Medicaid |
$2,963.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,720.86
|
| Rate for Payer: Cash Price |
$4,308.25
|
| Rate for Payer: Cigna Commercial |
$7,151.69
|
| Rate for Payer: First Health Commercial |
$8,185.67
|
| Rate for Payer: Humana Commercial |
$7,324.02
|
| Rate for Payer: Humana KY Medicaid |
$2,963.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,993.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,065.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,582.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,462.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,723.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.11
|
| Rate for Payer: PHCS Commercial |
$8,271.83
|
| Rate for Payer: United Healthcare All Payer |
$7,582.51
|
|
