|
TRIATHLON PS TIB INSRT #2 22MM
|
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 INSRT #2 25MM
|
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 INSRT #2 25MM
|
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 INSRT #3 11MM
|
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 INSRT #3 11MM
|
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 INSRT #3 13MM
|
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 INSRT #3 13MM
|
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 INSRT #3 16MM
|
Facility
|
IP
|
$8,088.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.46 |
| Max. Negotiated Rate |
$7,764.60 |
| Rate for Payer: Aetna Commercial |
$6,227.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,308.73
|
| Rate for Payer: Cash Price |
$4,044.06
|
| Rate for Payer: Cigna Commercial |
$6,713.14
|
| Rate for Payer: First Health Commercial |
$7,683.71
|
| Rate for Payer: Humana Commercial |
$6,874.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,632.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,969.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,117.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,507.32
|
| Rate for Payer: PHCS Commercial |
$7,764.60
|
| Rate for Payer: United Healthcare All Payer |
$7,117.55
|
|
|
TRIATHLON PS TIB INSRT #3 16MM
|
Facility
|
OP
|
$8,088.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.46 |
| Max. Negotiated Rate |
$7,764.60 |
| Rate for Payer: Aetna Commercial |
$6,227.85
|
| Rate for Payer: Anthem Medicaid |
$2,781.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,308.73
|
| Rate for Payer: Cash Price |
$4,044.06
|
| Rate for Payer: Cigna Commercial |
$6,713.14
|
| Rate for Payer: First Health Commercial |
$7,683.71
|
| Rate for Payer: Humana Commercial |
$6,874.90
|
| Rate for Payer: Humana KY Medicaid |
$2,781.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,809.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,632.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,969.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,426.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,837.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,117.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,507.32
|
| Rate for Payer: PHCS Commercial |
$7,764.60
|
| Rate for Payer: United Healthcare All Payer |
$7,117.55
|
|
|
TRIATHLON PS TIB INSRT #3 19MM
|
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 INSRT #3 19MM
|
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 INSRT #3 22MM
|
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 INSRT #3 22MM
|
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 INSRT #3 25MM
|
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 INSRT #3 25MM
|
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 INSRT #4 11MM
|
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 INSRT #4 11MM
|
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 INSRT #4 13MM
|
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 INSRT #4 13MM
|
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 INSRT #4 16MM
|
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 INSRT #4 16MM
|
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 INSRT #4 19MM
|
Facility
|
OP
|
$8,088.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.46 |
| Max. Negotiated Rate |
$7,764.60 |
| Rate for Payer: Aetna Commercial |
$6,227.85
|
| Rate for Payer: Anthem Medicaid |
$2,781.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,308.73
|
| Rate for Payer: Cash Price |
$4,044.06
|
| Rate for Payer: Cigna Commercial |
$6,713.14
|
| Rate for Payer: First Health Commercial |
$7,683.71
|
| Rate for Payer: Humana Commercial |
$6,874.90
|
| Rate for Payer: Humana KY Medicaid |
$2,781.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,809.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,632.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,969.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,426.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,837.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,117.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,507.32
|
| Rate for Payer: PHCS Commercial |
$7,764.60
|
| Rate for Payer: United Healthcare All Payer |
$7,117.55
|
|
|
TRIATHLON PS TIB INSRT #4 19MM
|
Facility
|
IP
|
$8,088.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.46 |
| Max. Negotiated Rate |
$7,764.60 |
| Rate for Payer: Aetna Commercial |
$6,227.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,308.73
|
| Rate for Payer: Cash Price |
$4,044.06
|
| Rate for Payer: Cigna Commercial |
$6,713.14
|
| Rate for Payer: First Health Commercial |
$7,683.71
|
| Rate for Payer: Humana Commercial |
$6,874.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,632.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,969.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,117.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,507.32
|
| Rate for Payer: PHCS Commercial |
$7,764.60
|
| Rate for Payer: United Healthcare All Payer |
$7,117.55
|
|
|
TRIATHLON PS TIB INSRT #4 22MM
|
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 INSRT #4 22MM
|
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
|
|
