|
TRIATHLON SYMMETRC PAT S27M*8M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S27M*8M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S29M*8M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S29M*8M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S31M*9M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S31M*9M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S33M*9M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON SYMMETRC PAT S33M*9M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRIATHLON TRIT BASEPLATE SZ 1
|
Facility
|
OP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 1
|
Facility
|
IP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 2
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 2
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 3
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 3
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 4
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 4
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 5
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 5
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 6
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 6
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 7
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 7
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
TRIATHLON TRIT BASEPLATE SZ 8
|
Facility
|
IP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON TRIT BASEPLATE SZ 8
|
Facility
|
OP
|
$9,168.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.55 |
| Max. Negotiated Rate |
$8,801.76 |
| Rate for Payer: Aetna Commercial |
$7,059.74
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.43
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna Commercial |
$7,609.85
|
| Rate for Payer: First Health Commercial |
$8,710.08
|
| Rate for Payer: Humana Commercial |
$7,793.23
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,334.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,976.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,326.27
|
| Rate for Payer: PHCS Commercial |
$8,801.76
|
| Rate for Payer: United Healthcare All Payer |
$8,068.28
|
|
|
TRIATHLON TS OFFSET ADAPTER 2M
|
Facility
|
IP
|
$8,460.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.01 |
| Max. Negotiated Rate |
$8,121.63 |
| Rate for Payer: Aetna Commercial |
$6,514.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,598.82
|
| Rate for Payer: Cash Price |
$4,230.02
|
| Rate for Payer: Cigna Commercial |
$7,021.82
|
| Rate for Payer: First Health Commercial |
$8,037.03
|
| Rate for Payer: Humana Commercial |
$7,191.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,937.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,243.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,444.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,768.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,360.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,837.42
|
| Rate for Payer: PHCS Commercial |
$8,121.63
|
| Rate for Payer: United Healthcare All Payer |
$7,444.83
|
|
