|
TRIATHLON N2 CS INSERT 8-11MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-13
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-13
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-16MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-16MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-19MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-19MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-22MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-22MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-25MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSERT 8-25MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 5-19 MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 5-19 MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 5-22 MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 5-22 MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 7-09 MM
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON N2 CS INSRT 7-09 MM
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
TRIATHLON PATELLA A32*10
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLON PATELLA A32*10
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLON PATELLA S27X8X3
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIATHLON PATELLA S27X8X3
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
TRIATHLON PATELLA S29X8X3
|
Facility
|
OP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem Medicaid |
$1,695.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Humana KY Medicaid |
$1,695.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,713.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
TRIATHLON PATELLA S29X8X3
|
Facility
|
IP
|
$4,930.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.02 |
| Max. Negotiated Rate |
$4,733.67 |
| Rate for Payer: Aetna Commercial |
$3,796.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,846.11
|
| Rate for Payer: Cash Price |
$2,465.46
|
| Rate for Payer: Cigna Commercial |
$4,092.66
|
| Rate for Payer: First Health Commercial |
$4,684.36
|
| Rate for Payer: Humana Commercial |
$4,191.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,043.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,639.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,339.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.58
|
| Rate for Payer: PHCS Commercial |
$4,733.67
|
| Rate for Payer: United Healthcare All Payer |
$4,339.20
|
|
|
TRIATHLON PATELLA S31X9X3
|
Facility
|
OP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem Medicaid |
$1,686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Humana KY Medicaid |
$1,686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
|
TRIATHLON PATELLA S31X9X3
|
Facility
|
IP
|
$4,903.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$4,707.47 |
| Rate for Payer: Aetna Commercial |
$3,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,824.82
|
| Rate for Payer: Cash Price |
$2,451.80
|
| Rate for Payer: Cigna Commercial |
$4,070.00
|
| Rate for Payer: First Health Commercial |
$4,658.43
|
| Rate for Payer: Humana Commercial |
$4,168.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,315.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,677.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,520.12
|
| Rate for Payer: PHCS Commercial |
$4,707.47
|
| Rate for Payer: United Healthcare All Payer |
$4,315.18
|
|
