|
TRIATHLON TS OFFSET ADAPTER 2M
|
Facility
|
OP
|
$8,460.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.01 |
| Max. Negotiated Rate |
$8,121.63 |
| Rate for Payer: Aetna Commercial |
$6,514.22
|
| Rate for Payer: Anthem Medicaid |
$2,909.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,598.82
|
| Rate for Payer: Cash Price |
$4,230.02
|
| Rate for Payer: Cigna Commercial |
$7,021.82
|
| Rate for Payer: First Health Commercial |
$8,037.03
|
| Rate for Payer: Humana Commercial |
$7,191.03
|
| Rate for Payer: Humana KY Medicaid |
$2,909.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,939.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,937.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,243.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,967.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,444.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,768.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,360.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,837.42
|
| Rate for Payer: PHCS Commercial |
$8,121.63
|
| Rate for Payer: United Healthcare All Payer |
$7,444.83
|
|
|
TRIATHLON TS OFFSET ADAPTER 4M
|
Facility
|
IP
|
$7,266.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.84 |
| Max. Negotiated Rate |
$6,975.48 |
| Rate for Payer: Aetna Commercial |
$5,594.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.57
|
| Rate for Payer: Cash Price |
$3,633.06
|
| Rate for Payer: Cigna Commercial |
$6,030.88
|
| Rate for Payer: First Health Commercial |
$6,902.81
|
| Rate for Payer: Humana Commercial |
$6,176.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.62
|
| Rate for Payer: PHCS Commercial |
$6,975.48
|
| Rate for Payer: United Healthcare All Payer |
$6,394.19
|
|
|
TRIATHLON TS OFFSET ADAPTER 4M
|
Facility
|
OP
|
$7,266.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.84 |
| Max. Negotiated Rate |
$6,975.48 |
| Rate for Payer: Aetna Commercial |
$5,594.91
|
| Rate for Payer: Anthem Medicaid |
$2,498.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.57
|
| Rate for Payer: Cash Price |
$3,633.06
|
| Rate for Payer: Cigna Commercial |
$6,030.88
|
| Rate for Payer: First Health Commercial |
$6,902.81
|
| Rate for Payer: Humana Commercial |
$6,176.20
|
| Rate for Payer: Humana KY Medicaid |
$2,498.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,548.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.62
|
| Rate for Payer: PHCS Commercial |
$6,975.48
|
| Rate for Payer: United Healthcare All Payer |
$6,394.19
|
|
|
TRIATHLON TS OFFSET ADAPTER 8M
|
Facility
|
OP
|
$8,460.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.01 |
| Max. Negotiated Rate |
$8,121.63 |
| Rate for Payer: Aetna Commercial |
$6,514.22
|
| Rate for Payer: Anthem Medicaid |
$2,909.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,598.82
|
| Rate for Payer: Cash Price |
$4,230.02
|
| Rate for Payer: Cigna Commercial |
$7,021.82
|
| Rate for Payer: First Health Commercial |
$8,037.03
|
| Rate for Payer: Humana Commercial |
$7,191.03
|
| Rate for Payer: Humana KY Medicaid |
$2,909.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,939.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,937.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,243.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,967.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,444.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,768.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,360.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,837.42
|
| Rate for Payer: PHCS Commercial |
$8,121.63
|
| Rate for Payer: United Healthcare All Payer |
$7,444.83
|
|
|
TRIATHLON TS OFFSET ADAPTER 8M
|
Facility
|
IP
|
$8,460.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.01 |
| Max. Negotiated Rate |
$8,121.63 |
| Rate for Payer: Aetna Commercial |
$6,514.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,598.82
|
| Rate for Payer: Cash Price |
$4,230.02
|
| Rate for Payer: Cigna Commercial |
$7,021.82
|
| Rate for Payer: First Health Commercial |
$8,037.03
|
| Rate for Payer: Humana Commercial |
$7,191.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,937.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,243.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,444.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,768.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,360.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,837.42
|
| Rate for Payer: PHCS Commercial |
$8,121.63
|
| Rate for Payer: United Healthcare All Payer |
$7,444.83
|
|
|
TRIATHLON TS OFFST ADAPTER 6MM
|
Facility
|
OP
|
$7,266.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.84 |
| Max. Negotiated Rate |
$6,975.48 |
| Rate for Payer: Aetna Commercial |
$5,594.91
|
| Rate for Payer: Anthem Medicaid |
$2,498.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.57
|
| Rate for Payer: Cash Price |
$3,633.06
|
| Rate for Payer: Cigna Commercial |
$6,030.88
|
| Rate for Payer: First Health Commercial |
$6,902.81
|
| Rate for Payer: Humana Commercial |
$6,176.20
|
| Rate for Payer: Humana KY Medicaid |
$2,498.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,548.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.62
|
| Rate for Payer: PHCS Commercial |
$6,975.48
|
| Rate for Payer: United Healthcare All Payer |
$6,394.19
|
|
|
TRIATHLON TS OFFST ADAPTER 6MM
|
Facility
|
IP
|
$7,266.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.84 |
| Max. Negotiated Rate |
$6,975.48 |
| Rate for Payer: Aetna Commercial |
$5,594.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.57
|
| Rate for Payer: Cash Price |
$3,633.06
|
| Rate for Payer: Cigna Commercial |
$6,030.88
|
| Rate for Payer: First Health Commercial |
$6,902.81
|
| Rate for Payer: Humana Commercial |
$6,176.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.19
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.62
|
| Rate for Payer: PHCS Commercial |
$6,975.48
|
| Rate for Payer: United Healthcare All Payer |
$6,394.19
|
|
|
TRIATHLON TS+ TIB INSERT #2 9M
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSERT #2 9M
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSERT #6 11
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSERT #6 11
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #1 9MM
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #1 9MM
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #3 9MM
|
Facility
|
OP
|
$15,655.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.62 |
| Max. Negotiated Rate |
$15,029.18 |
| Rate for Payer: Aetna Commercial |
$12,054.66
|
| Rate for Payer: Anthem Medicaid |
$5,383.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.21
|
| Rate for Payer: Cash Price |
$7,827.70
|
| Rate for Payer: Cigna Commercial |
$12,993.98
|
| Rate for Payer: First Health Commercial |
$14,872.63
|
| Rate for Payer: Humana Commercial |
$13,307.09
|
| Rate for Payer: Humana KY Medicaid |
$5,383.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,837.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,553.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,491.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,776.75
|
| Rate for Payer: Ohio Health Group HMO |
$11,741.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.23
|
| Rate for Payer: PHCS Commercial |
$15,029.18
|
| Rate for Payer: United Healthcare All Payer |
$13,776.75
|
|
|
TRIATHLON TS+ TIB INSRT #3 9MM
|
Facility
|
IP
|
$15,655.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.62 |
| Max. Negotiated Rate |
$15,029.18 |
| Rate for Payer: Aetna Commercial |
$12,054.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.21
|
| Rate for Payer: Cash Price |
$7,827.70
|
| Rate for Payer: Cigna Commercial |
$12,993.98
|
| Rate for Payer: First Health Commercial |
$14,872.63
|
| Rate for Payer: Humana Commercial |
$13,307.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,837.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,553.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,776.75
|
| Rate for Payer: Ohio Health Group HMO |
$11,741.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.23
|
| Rate for Payer: PHCS Commercial |
$15,029.18
|
| Rate for Payer: United Healthcare All Payer |
$13,776.75
|
|
|
TRIATHLON TS+ TIB INSRT #4 9MM
|
Facility
|
IP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLON TS+ TIB INSRT #4 9MM
|
Facility
|
OP
|
$13,364.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.49 |
| Max. Negotiated Rate |
$12,830.36 |
| Rate for Payer: Aetna Commercial |
$10,291.02
|
| Rate for Payer: Anthem Medicaid |
$4,596.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,424.67
|
| Rate for Payer: Cash Price |
$6,682.48
|
| Rate for Payer: Cigna Commercial |
$11,092.92
|
| Rate for Payer: First Health Commercial |
$12,696.71
|
| Rate for Payer: Humana Commercial |
$11,360.22
|
| Rate for Payer: Humana KY Medicaid |
$4,596.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,959.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,009.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,688.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,761.16
|
| Rate for Payer: Ohio Health Group HMO |
$10,023.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,691.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,627.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,221.82
|
| Rate for Payer: PHCS Commercial |
$12,830.36
|
| Rate for Payer: United Healthcare All Payer |
$11,761.16
|
|
|
TRIATHLON TS+ TIB INSRT #5 9MM
|
Facility
|
IP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLON TS+ TIB INSRT #5 9MM
|
Facility
|
OP
|
$12,496.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.03 |
| Max. Negotiated Rate |
$11,996.88 |
| Rate for Payer: Aetna Commercial |
$9,622.50
|
| Rate for Payer: Anthem Medicaid |
$4,297.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.47
|
| Rate for Payer: Cash Price |
$6,248.37
|
| Rate for Payer: Cigna Commercial |
$10,372.30
|
| Rate for Payer: First Health Commercial |
$11,871.91
|
| Rate for Payer: Humana Commercial |
$10,622.24
|
| Rate for Payer: Humana KY Medicaid |
$4,297.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.76
|
| Rate for Payer: PHCS Commercial |
$11,996.88
|
| Rate for Payer: United Healthcare All Payer |
$10,997.14
|
|
|
TRIATHLON TS+ TIB INSRT #6 9MM
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #6 9MM
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #7 9MM
|
Facility
|
IP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON TS+ TIB INSRT #7 9MM
|
Facility
|
OP
|
$15,656.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$15,029.89 |
| Rate for Payer: Aetna Commercial |
$12,055.23
|
| Rate for Payer: Anthem Medicaid |
$5,384.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.79
|
| Rate for Payer: Cash Price |
$7,828.07
|
| Rate for Payer: Cigna Commercial |
$12,994.60
|
| Rate for Payer: First Health Commercial |
$14,873.33
|
| Rate for Payer: Humana Commercial |
$13,307.72
|
| Rate for Payer: Humana KY Medicaid |
$5,384.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,838.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,492.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,777.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.74
|
| Rate for Payer: PHCS Commercial |
$15,029.89
|
| Rate for Payer: United Healthcare All Payer |
$13,777.40
|
|
|
TRIATHLON X3 ASY PAT A35*10MM
|
Facility
|
IP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
|
TRIATHLON X3 ASY PAT A35*10MM
|
Facility
|
OP
|
$4,896.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.02 |
| Max. Negotiated Rate |
$4,700.86 |
| Rate for Payer: Aetna Commercial |
$3,770.48
|
| Rate for Payer: Anthem Medicaid |
$1,683.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.45
|
| Rate for Payer: Cash Price |
$2,448.36
|
| Rate for Payer: Cigna Commercial |
$4,064.29
|
| Rate for Payer: First Health Commercial |
$4,651.89
|
| Rate for Payer: Humana Commercial |
$4,162.22
|
| Rate for Payer: Humana KY Medicaid |
$1,683.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.74
|
| Rate for Payer: PHCS Commercial |
$4,700.86
|
| Rate for Payer: United Healthcare All Payer |
$4,309.12
|
|
