|
TRIATHLON X3 CS INSERT 6-16MM
|
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 X3 CS INSERT 6-19MM
|
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 X3 CS INSERT 6-19MM
|
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 X3 CS INSERT 6-22MM
|
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 X3 CS INSERT 6-22MM
|
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 X3 CS INSERT 6-25MM
|
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 X3 CS INSERT 6-25MM
|
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 X3 CS INSERT 7-09MM
|
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 X3 CS INSERT 7-09MM
|
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 X3 CS INSERT 7-11MM
|
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 X3 CS INSERT 7-11MM
|
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 X3 CS INSERT 7-13MM
|
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 X3 CS INSERT 7-13MM
|
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 X3 CS INSERT 7-16MM
|
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 X3 CS INSERT 7-16MM
|
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 X3 CS INSERT 7-19MM
|
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 X3 CS INSERT 7-19MM
|
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 X3 CS INSERT 7-22MM
|
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 X3 CS INSERT 7-22MM
|
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 X3 CS INSERT 7-25MM
|
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 X3 CS INSERT 7-25MM
|
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 X3 CS INSERT 8-09MM
|
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 X3 CS INSERT 8-09MM
|
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 X3 CS INSERT 8-11MM
|
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 X3 CS INSERT 8-11MM
|
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
|
|
