|
TRIATHLON PS FEM COMP #7 LEFT
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #7 RIGHT
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #7 RIGHT
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #8 LEFT
|
Facility
|
OP
|
$16,316.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,895.09 |
| Max. Negotiated Rate |
$15,664.28 |
| Rate for Payer: Aetna Commercial |
$12,564.06
|
| Rate for Payer: Anthem Medicaid |
$5,611.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,727.23
|
| Rate for Payer: Cash Price |
$8,158.48
|
| Rate for Payer: Cigna Commercial |
$13,543.08
|
| Rate for Payer: First Health Commercial |
$15,501.11
|
| Rate for Payer: Humana Commercial |
$13,869.42
|
| Rate for Payer: Humana KY Medicaid |
$5,611.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,668.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,379.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,041.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,895.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,723.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,358.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,237.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,053.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,195.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,258.70
|
| Rate for Payer: PHCS Commercial |
$15,664.28
|
| Rate for Payer: United Healthcare All Payer |
$14,358.92
|
|
|
TRIATHLON PS FEM COMP #8 LEFT
|
Facility
|
IP
|
$16,316.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,895.09 |
| Max. Negotiated Rate |
$15,664.28 |
| Rate for Payer: Aetna Commercial |
$12,564.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,727.23
|
| Rate for Payer: Cash Price |
$8,158.48
|
| Rate for Payer: Cigna Commercial |
$13,543.08
|
| Rate for Payer: First Health Commercial |
$15,501.11
|
| Rate for Payer: Humana Commercial |
$13,869.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,379.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,041.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,358.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,237.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,053.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,195.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,258.70
|
| Rate for Payer: PHCS Commercial |
$15,664.28
|
| Rate for Payer: United Healthcare All Payer |
$14,358.92
|
|
|
TRIATHLON PS FEM COMP #8 RIGHT
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS FEM COMP #8 RIGHT
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
TRIATHLON PS TIB INSERT #1 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #1 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #2 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #2 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS 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 PS 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 PS TIB INSERT #4 9M
|
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 PS TIB INSERT #4 9M
|
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 PS TIB INSERT #4 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #4 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS 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 PS 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 PS TIB INSERT #6 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #6 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #7 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #7 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #8 9MM
|
Facility
|
OP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Humana KY Medicaid |
$3,027.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
|
TRIATHLON PS TIB INSERT #8 9MM
|
Facility
|
IP
|
$8,802.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.61 |
| Max. Negotiated Rate |
$8,449.96 |
| Rate for Payer: Aetna Commercial |
$6,777.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,865.59
|
| Rate for Payer: Cash Price |
$4,401.02
|
| Rate for Payer: Cigna Commercial |
$7,305.69
|
| Rate for Payer: First Health Commercial |
$8,361.94
|
| Rate for Payer: Humana Commercial |
$7,481.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,217.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,495.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,745.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,601.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,041.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,073.41
|
| Rate for Payer: PHCS Commercial |
$8,449.96
|
| Rate for Payer: United Healthcare All Payer |
$7,745.80
|
|
