|
TRIATHLON STEM EXTENDER 25MM
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRIATHLON STEM EXTENDER 25MM
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRIATHLON STEM EXTENDER 50MM
|
Facility
|
OP
|
$5,605.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.78 |
| Max. Negotiated Rate |
$5,381.75 |
| Rate for Payer: Aetna Commercial |
$4,316.61
|
| Rate for Payer: Anthem Medicaid |
$1,927.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,372.67
|
| Rate for Payer: Cash Price |
$2,803.00
|
| Rate for Payer: Cigna Commercial |
$4,652.97
|
| Rate for Payer: First Health Commercial |
$5,325.69
|
| Rate for Payer: Humana Commercial |
$4,765.09
|
| Rate for Payer: Humana KY Medicaid |
$1,927.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,947.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,596.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,681.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,966.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,933.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,204.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.86
|
| Rate for Payer: PHCS Commercial |
$5,381.75
|
| Rate for Payer: United Healthcare All Payer |
$4,933.27
|
|
|
TRIATHLON STEM EXTENDER 50MM
|
Facility
|
IP
|
$5,605.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.78 |
| Max. Negotiated Rate |
$5,381.75 |
| Rate for Payer: Aetna Commercial |
$4,316.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,372.67
|
| Rate for Payer: Cash Price |
$2,803.00
|
| Rate for Payer: Cigna Commercial |
$4,652.97
|
| Rate for Payer: First Health Commercial |
$5,325.69
|
| Rate for Payer: Humana Commercial |
$4,765.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,596.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,137.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,681.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,933.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,204.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.86
|
| Rate for Payer: PHCS Commercial |
$5,381.75
|
| Rate for Payer: United Healthcare All Payer |
$4,933.27
|
|
|
TRIATHLON SYMMETRC PAT S27M*8M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S27M*8M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S29M*8M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S29M*8M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S31M*9M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S31M*9M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S33M*9M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON SYMMETRC PAT S33M*9M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRIATHLON TRIT BASEPLATE SZ 1
|
Facility
|
OP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem Medicaid |
$3,084.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Humana KY Medicaid |
$3,084.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 1
|
Facility
|
IP
|
$8,968.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$8,609.76 |
| Rate for Payer: Aetna Commercial |
$6,905.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.43
|
| Rate for Payer: Cash Price |
$4,484.25
|
| Rate for Payer: Cigna Commercial |
$7,443.86
|
| Rate for Payer: First Health Commercial |
$8,520.08
|
| Rate for Payer: Humana Commercial |
$7,623.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,354.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,892.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.24
|
| Rate for Payer: PHCS Commercial |
$8,609.76
|
| Rate for Payer: United Healthcare All Payer |
$7,892.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 2
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 2
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 3
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 3
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 4
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 4
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 5
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 5
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 6
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 6
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 7
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
