|
TRIATHLON CR TIB INSERT #1-9MM
|
Facility
|
OP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem Medicaid |
$3,032.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Humana KY Medicaid |
$3,032.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSERT #2-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #2-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #3-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #3-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #4-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #4-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #5-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #5-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #6-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #6-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #7-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #7-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #8-9MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSERT #8-9MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSRT #1-11MM
|
Facility
|
OP
|
$8,816.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.95 |
| Max. Negotiated Rate |
$8,463.83 |
| Rate for Payer: Aetna Commercial |
$6,788.70
|
| Rate for Payer: Anthem Medicaid |
$3,031.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.86
|
| Rate for Payer: Cash Price |
$4,408.25
|
| Rate for Payer: Cigna Commercial |
$7,317.69
|
| Rate for Payer: First Health Commercial |
$8,375.67
|
| Rate for Payer: Humana Commercial |
$7,494.02
|
| Rate for Payer: Humana KY Medicaid |
$3,031.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.38
|
| Rate for Payer: PHCS Commercial |
$8,463.83
|
| Rate for Payer: United Healthcare All Payer |
$7,758.51
|
|
|
TRIATHLON CR TIB INSRT #1-11MM
|
Facility
|
IP
|
$8,816.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.95 |
| Max. Negotiated Rate |
$8,463.83 |
| Rate for Payer: Aetna Commercial |
$6,788.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.86
|
| Rate for Payer: Cash Price |
$4,408.25
|
| Rate for Payer: Cigna Commercial |
$7,317.69
|
| Rate for Payer: First Health Commercial |
$8,375.67
|
| Rate for Payer: Humana Commercial |
$7,494.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.38
|
| Rate for Payer: PHCS Commercial |
$8,463.83
|
| Rate for Payer: United Healthcare All Payer |
$7,758.51
|
|
|
TRIATHLON CR TIB INSRT #1-13MM
|
Facility
|
IP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #1-13MM
|
Facility
|
OP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem Medicaid |
$3,032.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Humana KY Medicaid |
$3,032.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #1-16MM
|
Facility
|
OP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem Medicaid |
$3,032.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Humana KY Medicaid |
$3,032.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #1-16MM
|
Facility
|
IP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #1-19MM
|
Facility
|
OP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem Medicaid |
$3,032.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Humana KY Medicaid |
$3,032.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #1-19MM
|
Facility
|
IP
|
$8,816.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.99 |
| Max. Negotiated Rate |
$8,463.97 |
| Rate for Payer: Aetna Commercial |
$6,788.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,876.98
|
| Rate for Payer: Cash Price |
$4,408.32
|
| Rate for Payer: Cigna Commercial |
$7,317.81
|
| Rate for Payer: First Health Commercial |
$8,375.81
|
| Rate for Payer: Humana Commercial |
$7,494.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.48
|
| Rate for Payer: PHCS Commercial |
$8,463.97
|
| Rate for Payer: United Healthcare All Payer |
$7,758.64
|
|
|
TRIATHLON CR TIB INSRT #2-11MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON CR TIB INSRT #2-11MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
