|
TRIATHLON PS TIB INSRT #1 11MM
|
Facility
|
OP
|
$9,050.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,715.07 |
| Max. Negotiated Rate |
$8,688.23 |
| Rate for Payer: Aetna Commercial |
$6,968.68
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.19
|
| Rate for Payer: Cash Price |
$4,525.12
|
| Rate for Payer: Cigna Commercial |
$7,511.70
|
| Rate for Payer: First Health Commercial |
$8,597.73
|
| Rate for Payer: Humana Commercial |
$7,692.70
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,873.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,244.67
|
| Rate for Payer: PHCS Commercial |
$8,688.23
|
| Rate for Payer: United Healthcare All Payer |
$7,964.21
|
|
|
TRIATHLON PS TIB INSRT #1 11MM
|
Facility
|
IP
|
$9,050.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,715.07 |
| Max. Negotiated Rate |
$8,688.23 |
| Rate for Payer: Aetna Commercial |
$6,968.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.19
|
| Rate for Payer: Cash Price |
$4,525.12
|
| Rate for Payer: Cigna Commercial |
$7,511.70
|
| Rate for Payer: First Health Commercial |
$8,597.73
|
| Rate for Payer: Humana Commercial |
$7,692.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,873.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,244.67
|
| Rate for Payer: PHCS Commercial |
$8,688.23
|
| Rate for Payer: United Healthcare All Payer |
$7,964.21
|
|
|
TRIATHLON PS TIB INSRT #1 13MM
|
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 INSRT #1 13MM
|
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 INSRT #1 16MM
|
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 INSRT #1 16MM
|
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 INSRT #1 19MM
|
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 INSRT #1 19MM
|
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 INSRT #1 22MM
|
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 INSRT #1 22MM
|
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 INSRT #1 25MM
|
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 INSRT #1 25MM
|
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 INSRT #2 11MM
|
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 INSRT #2 11MM
|
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 INSRT #2 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 PS TIB INSRT #2 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 PS TIB INSRT #2 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 PS TIB INSRT #2 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 PS TIB INSRT #2 19MM
|
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 INSRT #2 19MM
|
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 INSRT #2 22MM
|
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 INSRT #2 22MM
|
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 INSRT #2 25MM
|
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 INSRT #2 25MM
|
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 INSRT #3 11MM
|
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
|
|
