|
TRIATHLON N2 CS INSERT 8-16MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-19MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-19MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-22MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-22MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-25MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSERT 8-25MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 5-19 MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 5-19 MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 5-22 MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 5-22 MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 7-09 MM
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON N2 CS INSRT 7-09 MM
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
TRIATHLON PATELLA A32*10
|
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 PATELLA A32*10
|
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
|
|
|
TRIATHLON PATELLA S27X8X3
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIATHLON PATELLA S27X8X3
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIATHLON PATELLA S29X8X3
|
Facility
|
OP
|
$4,925.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.79 |
| Max. Negotiated Rate |
$4,728.94 |
| Rate for Payer: Aetna Commercial |
$3,793.00
|
| Rate for Payer: Anthem Medicaid |
$1,694.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.26
|
| Rate for Payer: Cash Price |
$2,462.99
|
| Rate for Payer: Cigna Commercial |
$4,088.56
|
| Rate for Payer: First Health Commercial |
$4,679.68
|
| Rate for Payer: Humana Commercial |
$4,187.08
|
| Rate for Payer: Humana KY Medicaid |
$1,694.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,711.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,728.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,285.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.93
|
| Rate for Payer: PHCS Commercial |
$4,728.94
|
| Rate for Payer: United Healthcare All Payer |
$4,334.86
|
|
|
TRIATHLON PATELLA S29X8X3
|
Facility
|
IP
|
$4,925.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.79 |
| Max. Negotiated Rate |
$4,728.94 |
| Rate for Payer: Aetna Commercial |
$3,793.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.26
|
| Rate for Payer: Cash Price |
$2,462.99
|
| Rate for Payer: Cigna Commercial |
$4,088.56
|
| Rate for Payer: First Health Commercial |
$4,679.68
|
| Rate for Payer: Humana Commercial |
$4,187.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,285.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.93
|
| Rate for Payer: PHCS Commercial |
$4,728.94
|
| Rate for Payer: United Healthcare All Payer |
$4,334.86
|
|
|
TRIATHLON PATELLA S31X9X3
|
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
|
|
|
TRIATHLON PATELLA S31X9X3
|
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 PATELLA S33X9X3
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIATHLON PATELLA S33X9X3
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
TRIATHLON PATELLA S36X10X3
|
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
|
|
|
TRIATHLON PATELLA S36X10X3
|
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
|
|
