|
TRIATHLON PS TIB INSRT #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #5 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #6 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 #7 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 #7 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 #7 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
|
|
