|
TRIATHLON TRIT BASEPLATE SZ 7
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 8
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 8
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON TS OFFSET ADAPTER 2M
|
Facility
|
OP
|
$8,260.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$7,929.63 |
| Rate for Payer: Aetna Commercial |
$6,360.22
|
| Rate for Payer: Anthem Medicaid |
$2,840.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.82
|
| Rate for Payer: Cash Price |
$4,130.02
|
| Rate for Payer: Cigna Commercial |
$6,855.82
|
| Rate for Payer: First Health Commercial |
$7,847.03
|
| Rate for Payer: Humana Commercial |
$7,021.03
|
| Rate for Payer: Humana KY Medicaid |
$2,840.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,869.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,897.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,560.61
|
| Rate for Payer: PHCS Commercial |
$7,929.63
|
| Rate for Payer: United Healthcare All Payer |
$7,268.83
|
|
|
TRIATHLON TS OFFSET ADAPTER 2M
|
Facility
|
IP
|
$8,260.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$7,929.63 |
| Rate for Payer: Aetna Commercial |
$6,360.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.82
|
| Rate for Payer: Cash Price |
$4,130.02
|
| Rate for Payer: Cigna Commercial |
$6,855.82
|
| Rate for Payer: First Health Commercial |
$7,847.03
|
| Rate for Payer: Humana Commercial |
$7,021.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,560.61
|
| Rate for Payer: PHCS Commercial |
$7,929.63
|
| Rate for Payer: United Healthcare All Payer |
$7,268.83
|
|
|
TRIATHLON TS OFFSET ADAPTER 4M
|
Facility
|
OP
|
$7,066.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$6,783.48 |
| Rate for Payer: Aetna Commercial |
$5,440.91
|
| Rate for Payer: Anthem Medicaid |
$2,430.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,511.57
|
| Rate for Payer: Cash Price |
$3,533.06
|
| Rate for Payer: Cigna Commercial |
$5,864.88
|
| Rate for Payer: First Health Commercial |
$6,712.81
|
| Rate for Payer: Humana Commercial |
$6,006.20
|
| Rate for Payer: Humana KY Medicaid |
$2,430.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,454.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,794.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,214.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,119.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,478.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,218.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,299.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,190.50
|
| Rate for Payer: PHCS Commercial |
$6,783.48
|
| Rate for Payer: United Healthcare All Payer |
$6,218.19
|
|
|
TRIATHLON TS OFFSET ADAPTER 4M
|
Facility
|
IP
|
$7,066.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$6,783.48 |
| Rate for Payer: Aetna Commercial |
$5,440.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,511.57
|
| Rate for Payer: Cash Price |
$3,533.06
|
| Rate for Payer: Cigna Commercial |
$5,864.88
|
| Rate for Payer: First Health Commercial |
$6,712.81
|
| Rate for Payer: Humana Commercial |
$6,006.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,794.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,214.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,119.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,218.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,299.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,190.50
|
| Rate for Payer: PHCS Commercial |
$6,783.48
|
| Rate for Payer: United Healthcare All Payer |
$6,218.19
|
|
|
TRIATHLON TS OFFSET ADAPTER 8M
|
Facility
|
OP
|
$8,260.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$7,929.63 |
| Rate for Payer: Aetna Commercial |
$6,360.22
|
| Rate for Payer: Anthem Medicaid |
$2,840.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.82
|
| Rate for Payer: Cash Price |
$4,130.02
|
| Rate for Payer: Cigna Commercial |
$6,855.82
|
| Rate for Payer: First Health Commercial |
$7,847.03
|
| Rate for Payer: Humana Commercial |
$7,021.03
|
| Rate for Payer: Humana KY Medicaid |
$2,840.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,869.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,897.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,560.61
|
| Rate for Payer: PHCS Commercial |
$7,929.63
|
| Rate for Payer: United Healthcare All Payer |
$7,268.83
|
|
|
TRIATHLON TS OFFSET ADAPTER 8M
|
Facility
|
IP
|
$8,260.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$7,929.63 |
| Rate for Payer: Aetna Commercial |
$6,360.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.82
|
| Rate for Payer: Cash Price |
$4,130.02
|
| Rate for Payer: Cigna Commercial |
$6,855.82
|
| Rate for Payer: First Health Commercial |
$7,847.03
|
| Rate for Payer: Humana Commercial |
$7,021.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,560.61
|
| Rate for Payer: PHCS Commercial |
$7,929.63
|
| Rate for Payer: United Healthcare All Payer |
$7,268.83
|
|
|
TRIATHLON TS OFFST ADAPTER 6MM
|
Facility
|
IP
|
$7,700.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.06 |
| Max. Negotiated Rate |
$7,392.47 |
| Rate for Payer: Aetna Commercial |
$5,929.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,006.38
|
| Rate for Payer: Cash Price |
$3,850.24
|
| Rate for Payer: Cigna Commercial |
$6,391.41
|
| Rate for Payer: First Health Commercial |
$7,315.47
|
| Rate for Payer: Humana Commercial |
$6,545.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,314.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,682.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,310.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,776.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,775.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,001.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.15
|
| Rate for Payer: PHCS Commercial |
$7,392.47
|
| Rate for Payer: United Healthcare All Payer |
$6,776.43
|
|
|
TRIATHLON TS OFFST ADAPTER 6MM
|
Facility
|
OP
|
$7,700.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.06 |
| Max. Negotiated Rate |
$7,392.47 |
| Rate for Payer: Aetna Commercial |
$5,929.38
|
| Rate for Payer: Anthem Medicaid |
$2,648.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,006.38
|
| Rate for Payer: Cash Price |
$3,850.24
|
| Rate for Payer: Cigna Commercial |
$6,391.41
|
| Rate for Payer: First Health Commercial |
$7,315.47
|
| Rate for Payer: Humana Commercial |
$6,545.42
|
| Rate for Payer: Humana KY Medicaid |
$2,648.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,675.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,314.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,682.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,310.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,701.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,776.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,775.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,001.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.15
|
| Rate for Payer: PHCS Commercial |
$7,392.47
|
| Rate for Payer: United Healthcare All Payer |
$6,776.43
|
|
|
TRIATHLON TS+ TIB INSERT #2 9M
|
Facility
|
OP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem Medicaid |
$5,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Humana KY Medicaid |
$5,210.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSERT #2 9M
|
Facility
|
IP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSERT #6 11
|
Facility
|
OP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem Medicaid |
$5,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Humana KY Medicaid |
$5,210.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSERT #6 11
|
Facility
|
IP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSRT #1 9MM
|
Facility
|
OP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem Medicaid |
$5,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Humana KY Medicaid |
$5,210.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSRT #1 9MM
|
Facility
|
IP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSRT #3 9MM
|
Facility
|
OP
|
$15,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.66 |
| Max. Negotiated Rate |
$14,545.15 |
| Rate for Payer: Aetna Commercial |
$11,666.42
|
| Rate for Payer: Anthem Medicaid |
$5,210.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,817.94
|
| Rate for Payer: Cash Price |
$7,575.60
|
| Rate for Payer: Cigna Commercial |
$12,575.50
|
| Rate for Payer: First Health Commercial |
$14,393.64
|
| Rate for Payer: Humana Commercial |
$12,878.52
|
| Rate for Payer: Humana KY Medicaid |
$5,210.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,423.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,181.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,696.87
|
| Rate for Payer: PHCS Commercial |
$14,545.15
|
| Rate for Payer: United Healthcare All Payer |
$13,333.06
|
|
|
TRIATHLON TS+ TIB INSRT #3 9MM
|
Facility
|
IP
|
$15,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.66 |
| Max. Negotiated Rate |
$14,545.15 |
| Rate for Payer: Aetna Commercial |
$11,666.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,817.94
|
| Rate for Payer: Cash Price |
$7,575.60
|
| Rate for Payer: Cigna Commercial |
$12,575.50
|
| Rate for Payer: First Health Commercial |
$14,393.64
|
| Rate for Payer: Humana Commercial |
$12,878.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,423.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,181.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,696.87
|
| Rate for Payer: PHCS Commercial |
$14,545.15
|
| Rate for Payer: United Healthcare All Payer |
$13,333.06
|
|
|
TRIATHLON TS+ TIB INSRT #4 9MM
|
Facility
|
IP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLON TS+ TIB INSRT #4 9MM
|
Facility
|
OP
|
$13,111.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.46 |
| Max. Negotiated Rate |
$12,586.75 |
| Rate for Payer: Aetna Commercial |
$10,095.62
|
| Rate for Payer: Anthem Medicaid |
$4,508.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,226.74
|
| Rate for Payer: Cash Price |
$6,555.60
|
| Rate for Payer: Cigna Commercial |
$10,882.30
|
| Rate for Payer: First Health Commercial |
$12,455.64
|
| Rate for Payer: Humana Commercial |
$11,144.52
|
| Rate for Payer: Humana KY Medicaid |
$4,508.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,554.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,751.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,676.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,599.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,537.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,833.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,622.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,704.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,064.47
|
| Rate for Payer: PHCS Commercial |
$12,586.75
|
| Rate for Payer: United Healthcare All Payer |
$11,537.86
|
|
|
TRIATHLON TS+ TIB INSRT #5 9MM
|
Facility
|
IP
|
$12,247.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,592.20 |
| Max. Negotiated Rate |
$11,757.81 |
| Rate for Payer: Aetna Commercial |
$9,430.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.22
|
| Rate for Payer: Cash Price |
$6,123.86
|
| Rate for Payer: Cigna Commercial |
$10,165.61
|
| Rate for Payer: First Health Commercial |
$11,635.33
|
| Rate for Payer: Humana Commercial |
$10,410.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,777.99
|
| Rate for Payer: Ohio Health Group HMO |
$9,185.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.79
|
| Rate for Payer: PHCS Commercial |
$11,757.81
|
| Rate for Payer: United Healthcare All Payer |
$10,777.99
|
|
|
TRIATHLON TS+ TIB INSRT #5 9MM
|
Facility
|
OP
|
$12,247.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,592.20 |
| Max. Negotiated Rate |
$11,757.81 |
| Rate for Payer: Aetna Commercial |
$9,430.74
|
| Rate for Payer: Anthem Medicaid |
$4,211.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.22
|
| Rate for Payer: Cash Price |
$6,123.86
|
| Rate for Payer: Cigna Commercial |
$10,165.61
|
| Rate for Payer: First Health Commercial |
$11,635.33
|
| Rate for Payer: Humana Commercial |
$10,410.56
|
| Rate for Payer: Humana KY Medicaid |
$4,211.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,254.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,296.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,777.99
|
| Rate for Payer: Ohio Health Group HMO |
$9,185.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.79
|
| Rate for Payer: PHCS Commercial |
$11,757.81
|
| Rate for Payer: United Healthcare All Payer |
$10,777.99
|
|
|
TRIATHLON TS+ TIB INSRT #6 9MM
|
Facility
|
OP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem Medicaid |
$5,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Humana KY Medicaid |
$5,210.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
|
TRIATHLON TS+ TIB INSRT #6 9MM
|
Facility
|
IP
|
$15,151.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.75 |
| Max. Negotiated Rate |
$14,545.84 |
| Rate for Payer: Aetna Commercial |
$11,666.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,818.50
|
| Rate for Payer: Cash Price |
$7,575.96
|
| Rate for Payer: Cigna Commercial |
$12,576.09
|
| Rate for Payer: First Health Commercial |
$14,394.32
|
| Rate for Payer: Humana Commercial |
$12,879.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,424.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,182.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,697.10
|
| Rate for Payer: PHCS Commercial |
$14,545.84
|
| Rate for Payer: United Healthcare All Payer |
$13,333.69
|
|
