|
TRIATHLON PS FEM COMP #6 LEFT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #6 RIGHT
|
Facility
|
OP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem Medicaid |
$3,822.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Humana KY Medicaid |
$3,822.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #6 RIGHT
|
Facility
|
IP
|
$11,113.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.81 |
| Max. Negotiated Rate |
$10,669.36 |
| Rate for Payer: Aetna Commercial |
$8,557.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.86
|
| Rate for Payer: Cash Price |
$5,556.96
|
| Rate for Payer: Cigna Commercial |
$9,224.55
|
| Rate for Payer: First Health Commercial |
$10,558.22
|
| Rate for Payer: Humana Commercial |
$9,446.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,202.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,780.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.32
|
| Rate for Payer: PHCS Commercial |
$10,669.36
|
| Rate for Payer: United Healthcare All Payer |
$9,780.25
|
|
|
TRIATHLON PS FEM COMP #7 LEFT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #7 LEFT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #7 RIGHT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #7 RIGHT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #8 LEFT
|
Facility
|
OP
|
$15,794.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,053.33 |
| Max. Negotiated Rate |
$15,163.08 |
| Rate for Payer: Aetna Commercial |
$12,162.06
|
| Rate for Payer: Anthem Medicaid |
$5,431.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,320.01
|
| Rate for Payer: Cash Price |
$7,897.44
|
| Rate for Payer: Cigna Commercial |
$13,109.75
|
| Rate for Payer: First Health Commercial |
$15,005.14
|
| Rate for Payer: Humana Commercial |
$13,425.65
|
| Rate for Payer: Humana KY Medicaid |
$5,431.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,487.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,951.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,656.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,738.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,540.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,899.49
|
| Rate for Payer: Ohio Health Group HMO |
$11,846.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,158.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,053.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.41
|
| Rate for Payer: PHCS Commercial |
$15,163.08
|
| Rate for Payer: United Healthcare All Payer |
$13,899.49
|
|
|
TRIATHLON PS FEM COMP #8 LEFT
|
Facility
|
IP
|
$15,794.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,053.33 |
| Max. Negotiated Rate |
$15,163.08 |
| Rate for Payer: Aetna Commercial |
$12,162.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,320.01
|
| Rate for Payer: Cash Price |
$7,897.44
|
| Rate for Payer: Cigna Commercial |
$13,109.75
|
| Rate for Payer: First Health Commercial |
$15,005.14
|
| Rate for Payer: Humana Commercial |
$13,425.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,951.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,656.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,738.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,899.49
|
| Rate for Payer: Ohio Health Group HMO |
$11,846.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,158.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,053.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.41
|
| Rate for Payer: PHCS Commercial |
$15,163.08
|
| Rate for Payer: United Healthcare All Payer |
$13,899.49
|
|
|
TRIATHLON PS FEM COMP #8 RIGHT
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS FEM COMP #8 RIGHT
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
TRIATHLON PS TIB INSERT #1 9MM
|
Facility
|
OP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem Medicaid |
$2,958.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Humana KY Medicaid |
$2,958.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS TIB INSERT #1 9MM
|
Facility
|
IP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS TIB INSERT #2 9MM
|
Facility
|
OP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem Medicaid |
$2,958.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Humana KY Medicaid |
$2,958.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS TIB INSERT #2 9MM
|
Facility
|
IP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS 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 PS 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 PS TIB INSERT #4 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 PS TIB INSERT #4 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 PS TIB INSERT #4 9MM
|
Facility
|
IP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS TIB INSERT #4 9MM
|
Facility
|
OP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem Medicaid |
$2,958.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Humana KY Medicaid |
$2,958.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS 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 PS 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 PS TIB INSERT #6 9MM
|
Facility
|
IP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
|
TRIATHLON PS TIB INSERT #6 9MM
|
Facility
|
OP
|
$8,602.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.27 |
| Max. Negotiated Rate |
$8,257.96 |
| Rate for Payer: Aetna Commercial |
$6,623.57
|
| Rate for Payer: Anthem Medicaid |
$2,958.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.59
|
| Rate for Payer: Cash Price |
$4,301.02
|
| Rate for Payer: Cigna Commercial |
$7,139.69
|
| Rate for Payer: First Health Commercial |
$8,171.94
|
| Rate for Payer: Humana Commercial |
$7,311.73
|
| Rate for Payer: Humana KY Medicaid |
$2,958.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.63
|
| Rate for Payer: PHCS Commercial |
$8,257.96
|
| Rate for Payer: United Healthcare All Payer |
$7,569.80
|
|
