|
TRIATHLON PS TIB INSRT #7 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 #7 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 #7 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 #7 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 #7 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 #7 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 #7 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 #7 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 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 #8 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 #8 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 #8 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 #8 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 #8 16MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON PS TIB INSRT #8 16MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON PS TIB INSRT #8 19MM
|
Facility
|
OP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem Medicaid |
$2,950.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Humana KY Medicaid |
$2,950.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON PS TIB INSRT #8 19MM
|
Facility
|
IP
|
$8,580.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.04 |
| Max. Negotiated Rate |
$8,236.92 |
| Rate for Payer: Aetna Commercial |
$6,606.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,692.49
|
| Rate for Payer: Cash Price |
$4,290.06
|
| Rate for Payer: Cigna Commercial |
$7,121.50
|
| Rate for Payer: First Health Commercial |
$8,151.11
|
| Rate for Payer: Humana Commercial |
$7,293.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,035.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,332.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,550.51
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,864.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,464.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,920.28
|
| Rate for Payer: PHCS Commercial |
$8,236.92
|
| Rate for Payer: United Healthcare All Payer |
$7,550.51
|
|
|
TRIATHLON PS TIB INSRT #8 22MM
|
Facility
|
OP
|
$9,167.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.11 |
| Max. Negotiated Rate |
$8,800.36 |
| Rate for Payer: Aetna Commercial |
$7,058.62
|
| Rate for Payer: Anthem Medicaid |
$3,152.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,150.29
|
| Rate for Payer: Cash Price |
$4,583.52
|
| Rate for Payer: Cigna Commercial |
$7,608.64
|
| Rate for Payer: First Health Commercial |
$8,708.69
|
| Rate for Payer: Humana Commercial |
$7,791.98
|
| Rate for Payer: Humana KY Medicaid |
$3,152.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,516.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,765.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,215.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,067.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,875.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,333.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,975.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.26
|
| Rate for Payer: PHCS Commercial |
$8,800.36
|
| Rate for Payer: United Healthcare All Payer |
$8,067.00
|
|
|
TRIATHLON PS TIB INSRT #8 22MM
|
Facility
|
IP
|
$9,167.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.11 |
| Max. Negotiated Rate |
$8,800.36 |
| Rate for Payer: Aetna Commercial |
$7,058.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,150.29
|
| Rate for Payer: Cash Price |
$4,583.52
|
| Rate for Payer: Cigna Commercial |
$7,608.64
|
| Rate for Payer: First Health Commercial |
$8,708.69
|
| Rate for Payer: Humana Commercial |
$7,791.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,516.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,765.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,067.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,875.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,333.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,975.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.26
|
| Rate for Payer: PHCS Commercial |
$8,800.36
|
| Rate for Payer: United Healthcare All Payer |
$8,067.00
|
|
|
TRIATHLON PS TIB INSRT #8 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 #8 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 STEM EXTENDER 25MM
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRIATHLON STEM EXTENDER 25MM
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRIATHLON STEM EXTENDER 50MM
|
Facility
|
IP
|
$5,649.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,694.78 |
| Max. Negotiated Rate |
$5,423.30 |
| Rate for Payer: Aetna Commercial |
$4,349.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,406.43
|
| Rate for Payer: Cash Price |
$2,824.64
|
| Rate for Payer: Cigna Commercial |
$4,688.89
|
| Rate for Payer: First Health Commercial |
$5,366.81
|
| Rate for Payer: Humana Commercial |
$4,801.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,632.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,169.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,971.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,236.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,519.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,914.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.00
|
| Rate for Payer: PHCS Commercial |
$5,423.30
|
| Rate for Payer: United Healthcare All Payer |
$4,971.36
|
|
|
TRIATHLON STEM EXTENDER 50MM
|
Facility
|
OP
|
$5,649.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,694.78 |
| Max. Negotiated Rate |
$5,423.30 |
| Rate for Payer: Aetna Commercial |
$4,349.94
|
| Rate for Payer: Anthem Medicaid |
$1,942.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,406.43
|
| Rate for Payer: Cash Price |
$2,824.64
|
| Rate for Payer: Cigna Commercial |
$4,688.89
|
| Rate for Payer: First Health Commercial |
$5,366.81
|
| Rate for Payer: Humana Commercial |
$4,801.88
|
| Rate for Payer: Humana KY Medicaid |
$1,942.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,962.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,632.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,169.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,981.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,971.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,236.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,519.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,914.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.00
|
| Rate for Payer: PHCS Commercial |
$5,423.30
|
| Rate for Payer: United Healthcare All Payer |
$4,971.36
|
|
