|
TRIATHLON PS TIB INSRT #4 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 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 #5 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 #5 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 #5 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 #5 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 #5 16MM
|
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 #5 16MM
|
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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #6 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 #6 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 #6 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 #6 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 #6 16MM
|
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 #6 16MM
|
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 #6 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 #6 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 #6 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 #6 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 #6 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
|
|
