|
TRIATHLON CR TIB INSRT #5-11MM
|
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
|
|
|
TRIATHLON CR TIB INSRT #5-13MM
|
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 #5-13MM
|
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 #5-16MM
|
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 #5-16MM
|
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 #5-19MM
|
Facility
|
OP
|
$8,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,486.44 |
| Max. Negotiated Rate |
$7,956.60 |
| Rate for Payer: Aetna Commercial |
$6,381.85
|
| Rate for Payer: Anthem Medicaid |
$2,850.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,464.73
|
| Rate for Payer: Cash Price |
$4,144.06
|
| Rate for Payer: Cigna Commercial |
$6,879.14
|
| Rate for Payer: First Health Commercial |
$7,873.71
|
| Rate for Payer: Humana Commercial |
$7,044.90
|
| Rate for Payer: Humana KY Medicaid |
$2,850.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,879.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,796.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,116.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,486.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,907.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,293.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,630.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,210.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,718.80
|
| Rate for Payer: PHCS Commercial |
$7,956.60
|
| Rate for Payer: United Healthcare All Payer |
$7,293.55
|
|
|
TRIATHLON CR TIB INSRT #5-19MM
|
Facility
|
IP
|
$8,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,486.44 |
| Max. Negotiated Rate |
$7,956.60 |
| Rate for Payer: Aetna Commercial |
$6,381.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,464.73
|
| Rate for Payer: Cash Price |
$4,144.06
|
| Rate for Payer: Cigna Commercial |
$6,879.14
|
| Rate for Payer: First Health Commercial |
$7,873.71
|
| Rate for Payer: Humana Commercial |
$7,044.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,796.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,116.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,486.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,293.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,630.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,210.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,718.80
|
| Rate for Payer: PHCS Commercial |
$7,956.60
|
| Rate for Payer: United Healthcare All Payer |
$7,293.55
|
|
|
TRIATHLON CR TIB INSRT 6-10
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INSRT 6-10
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIATHLON CR TIB INSRT #6-11MM
|
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
|
|
|
TRIATHLON CR TIB INSRT #6-11MM
|
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 #6-13MM
|
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 #6-13MM
|
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 #6-16MM
|
Facility
|
OP
|
$8,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,486.44 |
| Max. Negotiated Rate |
$7,956.60 |
| Rate for Payer: Aetna Commercial |
$6,381.85
|
| Rate for Payer: Anthem Medicaid |
$2,850.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,464.73
|
| Rate for Payer: Cash Price |
$4,144.06
|
| Rate for Payer: Cigna Commercial |
$6,879.14
|
| Rate for Payer: First Health Commercial |
$7,873.71
|
| Rate for Payer: Humana Commercial |
$7,044.90
|
| Rate for Payer: Humana KY Medicaid |
$2,850.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,879.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,796.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,116.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,486.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,907.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,293.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,630.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,210.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,718.80
|
| Rate for Payer: PHCS Commercial |
$7,956.60
|
| Rate for Payer: United Healthcare All Payer |
$7,293.55
|
|
|
TRIATHLON CR TIB INSRT #6-16MM
|
Facility
|
IP
|
$8,288.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,486.44 |
| Max. Negotiated Rate |
$7,956.60 |
| Rate for Payer: Aetna Commercial |
$6,381.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,464.73
|
| Rate for Payer: Cash Price |
$4,144.06
|
| Rate for Payer: Cigna Commercial |
$6,879.14
|
| Rate for Payer: First Health Commercial |
$7,873.71
|
| Rate for Payer: Humana Commercial |
$7,044.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,796.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,116.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,486.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,293.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,216.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,630.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,210.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,718.80
|
| Rate for Payer: PHCS Commercial |
$7,956.60
|
| Rate for Payer: United Healthcare All Payer |
$7,293.55
|
|
|
TRIATHLON CR TIB INSRT #6-19MM
|
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 #6-19MM
|
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 #7-11MM
|
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 #7-11MM
|
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
|
|
|
TRIATHLON CR TIB INSRT #7-13MM
|
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 #7-13MM
|
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 #7-16MM
|
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 #7-16MM
|
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 #7-19MM
|
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 #7-19MM
|
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
|
|
