|
CROSSLINK FIN GLENOID 40XS
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CROSSLINK FIN GLENOID 44MM
|
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 44MM
|
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 48MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CROSSLINK FIN GLENOID 48MM
|
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
|
|
|
CROSSLINK FIN GLENOID 52MM
|
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 52MM
|
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 56MM
|
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 56MM
|
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 56XL
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| 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 |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
CROSSLINK FIN GLENOID 56XL
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
CROSSTELLA OTW 2*100*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
|
|
CROSSTELLA OTW 2*100*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*120*150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSSTELLA OTW 2*120*150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSSTELLA OTW 2*150*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*150*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*200*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*200*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*20*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*20*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*40*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*40*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*50*150
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
CROSSTELLA OTW 2*50*150
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
