|
CROSPERIO OTW 3.5*200*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3.5*200*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3.5*40*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3.5*40*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
|
|
CROSPERIO OTW 3.5*80*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3.5*80*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3*80*150
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSPERIO OTW 3*80*150
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
CROSS BOSS
|
Facility
|
OP
|
$6,860.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$891.92 |
| Max. Negotiated Rate |
$6,586.51 |
| Rate for Payer: Aetna Commercial |
$5,282.93
|
| Rate for Payer: Anthem Medicaid |
$2,359.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.54
|
| Rate for Payer: Cash Price |
$3,430.48
|
| Rate for Payer: Cigna Commercial |
$5,694.59
|
| Rate for Payer: First Health Commercial |
$6,517.90
|
| Rate for Payer: Humana Commercial |
$5,831.81
|
| Rate for Payer: Humana KY Medicaid |
$2,359.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,383.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,063.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,058.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.89
|
| Rate for Payer: PHCS Commercial |
$6,586.51
|
| Rate for Payer: United Healthcare All Payer |
$6,037.64
|
|
|
CROSS BOSS
|
Facility
|
IP
|
$6,860.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$891.92 |
| Max. Negotiated Rate |
$6,586.51 |
| Rate for Payer: Aetna Commercial |
$5,282.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.54
|
| Rate for Payer: Cash Price |
$3,430.48
|
| Rate for Payer: Cigna Commercial |
$5,694.59
|
| Rate for Payer: First Health Commercial |
$6,517.90
|
| Rate for Payer: Humana Commercial |
$5,831.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,063.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,058.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.89
|
| Rate for Payer: PHCS Commercial |
$6,586.51
|
| Rate for Payer: United Healthcare All Payer |
$6,037.64
|
|
|
CROSSLINK ANCHOR PG GLENOID 40
|
Facility
|
OP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem Medicaid |
$3,375.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Humana KY Medicaid |
$3,375.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,410.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,443.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 40
|
Facility
|
IP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 44
|
Facility
|
IP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 44
|
Facility
|
OP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem Medicaid |
$3,375.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Humana KY Medicaid |
$3,375.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,410.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,443.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 48
|
Facility
|
OP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem Medicaid |
$3,375.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Humana KY Medicaid |
$3,375.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,410.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,443.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 48
|
Facility
|
IP
|
$9,816.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.10 |
| Max. Negotiated Rate |
$9,423.49 |
| Rate for Payer: Aetna Commercial |
$7,558.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,656.59
|
| Rate for Payer: Cash Price |
$4,908.07
|
| Rate for Payer: Cigna Commercial |
$8,147.40
|
| Rate for Payer: First Health Commercial |
$9,325.33
|
| Rate for Payer: Humana Commercial |
$8,343.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,049.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,944.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,638.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,362.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.00
|
| Rate for Payer: PHCS Commercial |
$9,423.49
|
| Rate for Payer: United Healthcare All Payer |
$8,638.20
|
|
|
CROSSLINK ANCHR PG GLENOD 52MM
|
Facility
|
IP
|
$9,417.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.33 |
| Max. Negotiated Rate |
$9,041.24 |
| Rate for Payer: Aetna Commercial |
$7,251.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,346.01
|
| Rate for Payer: Cash Price |
$4,708.98
|
| Rate for Payer: Cigna Commercial |
$7,816.91
|
| Rate for Payer: First Health Commercial |
$8,947.06
|
| Rate for Payer: Humana Commercial |
$8,005.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,722.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,950.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,825.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,287.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,063.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.57
|
| Rate for Payer: PHCS Commercial |
$9,041.24
|
| Rate for Payer: United Healthcare All Payer |
$8,287.80
|
|
|
CROSSLINK ANCHR PG GLENOD 52MM
|
Facility
|
OP
|
$9,417.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.33 |
| Max. Negotiated Rate |
$9,041.24 |
| Rate for Payer: Aetna Commercial |
$7,251.83
|
| Rate for Payer: Anthem Medicaid |
$3,238.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,346.01
|
| Rate for Payer: Cash Price |
$4,708.98
|
| Rate for Payer: Cigna Commercial |
$7,816.91
|
| Rate for Payer: First Health Commercial |
$8,947.06
|
| Rate for Payer: Humana Commercial |
$8,005.27
|
| Rate for Payer: Humana KY Medicaid |
$3,238.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,722.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,950.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,825.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,303.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,287.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,063.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.57
|
| Rate for Payer: PHCS Commercial |
$9,041.24
|
| Rate for Payer: United Healthcare All Payer |
$8,287.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56MM
|
Facility
|
OP
|
$9,417.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.33 |
| Max. Negotiated Rate |
$9,041.24 |
| Rate for Payer: Aetna Commercial |
$7,251.83
|
| Rate for Payer: Anthem Medicaid |
$3,238.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,346.01
|
| Rate for Payer: Cash Price |
$4,708.98
|
| Rate for Payer: Cigna Commercial |
$7,816.91
|
| Rate for Payer: First Health Commercial |
$8,947.06
|
| Rate for Payer: Humana Commercial |
$8,005.27
|
| Rate for Payer: Humana KY Medicaid |
$3,238.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,722.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,950.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,825.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,303.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,287.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,063.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.57
|
| Rate for Payer: PHCS Commercial |
$9,041.24
|
| Rate for Payer: United Healthcare All Payer |
$8,287.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56MM
|
Facility
|
IP
|
$9,417.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.33 |
| Max. Negotiated Rate |
$9,041.24 |
| Rate for Payer: Aetna Commercial |
$7,251.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,346.01
|
| Rate for Payer: Cash Price |
$4,708.98
|
| Rate for Payer: Cigna Commercial |
$7,816.91
|
| Rate for Payer: First Health Commercial |
$8,947.06
|
| Rate for Payer: Humana Commercial |
$8,005.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,722.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,950.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,825.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,287.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,063.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.57
|
| Rate for Payer: PHCS Commercial |
$9,041.24
|
| Rate for Payer: United Healthcare All Payer |
$8,287.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56XL
|
Facility
|
IP
|
$8,229.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.77 |
| Max. Negotiated Rate |
$7,899.85 |
| Rate for Payer: Aetna Commercial |
$6,336.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.63
|
| Rate for Payer: Cash Price |
$4,114.50
|
| Rate for Payer: Cigna Commercial |
$6,830.08
|
| Rate for Payer: First Health Commercial |
$7,817.56
|
| Rate for Payer: Humana Commercial |
$6,994.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,747.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,171.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,550.99
|
| Rate for Payer: PHCS Commercial |
$7,899.85
|
| Rate for Payer: United Healthcare All Payer |
$7,241.53
|
|
|
CROSSLINK ANCHR PG GLENOD 56XL
|
Facility
|
OP
|
$8,229.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.77 |
| Max. Negotiated Rate |
$7,899.85 |
| Rate for Payer: Aetna Commercial |
$6,336.34
|
| Rate for Payer: Anthem Medicaid |
$2,829.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.63
|
| Rate for Payer: Cash Price |
$4,114.50
|
| Rate for Payer: Cigna Commercial |
$6,830.08
|
| Rate for Payer: First Health Commercial |
$7,817.56
|
| Rate for Payer: Humana Commercial |
$6,994.66
|
| Rate for Payer: Humana KY Medicaid |
$2,829.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,858.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,747.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,886.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,171.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,550.99
|
| Rate for Payer: PHCS Commercial |
$7,899.85
|
| Rate for Payer: United Healthcare All Payer |
$7,241.53
|
|
|
CROSSLINK FIN GLENOID 40MM
|
Facility
|
IP
|
$8,899.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$8,543.12 |
| Rate for Payer: Aetna Commercial |
$6,852.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,941.28
|
| Rate for Payer: Cash Price |
$4,449.54
|
| Rate for Payer: Cigna Commercial |
$7,386.24
|
| Rate for Payer: First Health Commercial |
$8,454.13
|
| Rate for Payer: Humana Commercial |
$7,564.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,297.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,567.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,669.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,831.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,674.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,779.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,758.71
|
| Rate for Payer: PHCS Commercial |
$8,543.12
|
| Rate for Payer: United Healthcare All Payer |
$7,831.19
|
|
|
CROSSLINK FIN GLENOID 40MM
|
Facility
|
OP
|
$8,899.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$8,543.12 |
| Rate for Payer: Aetna Commercial |
$6,852.29
|
| Rate for Payer: Anthem Medicaid |
$3,060.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,941.28
|
| Rate for Payer: Cash Price |
$4,449.54
|
| Rate for Payer: Cigna Commercial |
$7,386.24
|
| Rate for Payer: First Health Commercial |
$8,454.13
|
| Rate for Payer: Humana Commercial |
$7,564.22
|
| Rate for Payer: Humana KY Medicaid |
$3,060.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,091.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,297.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,567.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,669.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,121.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,831.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,674.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,779.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,758.71
|
| Rate for Payer: PHCS Commercial |
$8,543.12
|
| Rate for Payer: United Healthcare All Payer |
$7,831.19
|
|
|
CROSSLINK FIN GLENOID 40XS
|
Facility
|
OP
|
$7,090.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.78 |
| Max. Negotiated Rate |
$6,807.02 |
| Rate for Payer: Aetna Commercial |
$5,459.80
|
| Rate for Payer: Anthem Medicaid |
$2,438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.71
|
| Rate for Payer: Cash Price |
$3,545.32
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: First Health Commercial |
$6,736.12
|
| Rate for Payer: Humana Commercial |
$6,027.05
|
| Rate for Payer: Humana KY Medicaid |
$2,438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,232.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,317.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.10
|
| Rate for Payer: PHCS Commercial |
$6,807.02
|
| Rate for Payer: United Healthcare All Payer |
$6,239.77
|
|
