|
CROSPERIO OTW 3.5*40*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 3.5*80*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 3.5*80*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 3*80*150
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSPERIO OTW 3*80*150
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
CROSS BOSS
|
Facility
|
OP
|
$7,060.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,118.28 |
| Max. Negotiated Rate |
$6,778.51 |
| Rate for Payer: Aetna Commercial |
$5,436.93
|
| Rate for Payer: Anthem Medicaid |
$2,428.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,507.54
|
| Rate for Payer: Cash Price |
$3,530.48
|
| Rate for Payer: Cigna Commercial |
$5,860.59
|
| Rate for Payer: First Health Commercial |
$6,707.90
|
| Rate for Payer: Humana Commercial |
$6,001.81
|
| Rate for Payer: Humana KY Medicaid |
$2,428.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,452.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,210.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,476.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,213.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,295.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,648.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,143.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.06
|
| Rate for Payer: PHCS Commercial |
$6,778.51
|
| Rate for Payer: United Healthcare All Payer |
$6,213.64
|
|
|
CROSS BOSS
|
Facility
|
IP
|
$7,060.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,118.28 |
| Max. Negotiated Rate |
$6,778.51 |
| Rate for Payer: Aetna Commercial |
$5,436.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,507.54
|
| Rate for Payer: Cash Price |
$3,530.48
|
| Rate for Payer: Cigna Commercial |
$5,860.59
|
| Rate for Payer: First Health Commercial |
$6,707.90
|
| Rate for Payer: Humana Commercial |
$6,001.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,210.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,213.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,295.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,648.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,143.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.06
|
| Rate for Payer: PHCS Commercial |
$6,778.51
|
| Rate for Payer: United Healthcare All Payer |
$6,213.64
|
|
|
CROSSLINK ANCHOR PG GLENOID 40
|
Facility
|
IP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 40
|
Facility
|
OP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem Medicaid |
$3,444.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Humana KY Medicaid |
$3,444.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,479.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,513.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 44
|
Facility
|
IP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 44
|
Facility
|
OP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem Medicaid |
$3,444.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Humana KY Medicaid |
$3,444.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,479.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,513.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 48
|
Facility
|
IP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHOR PG GLENOID 48
|
Facility
|
OP
|
$10,016.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,004.84 |
| Max. Negotiated Rate |
$9,615.49 |
| Rate for Payer: Aetna Commercial |
$7,712.43
|
| Rate for Payer: Anthem Medicaid |
$3,444.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,812.59
|
| Rate for Payer: Cash Price |
$5,008.07
|
| Rate for Payer: Cigna Commercial |
$8,313.40
|
| Rate for Payer: First Health Commercial |
$9,515.33
|
| Rate for Payer: Humana Commercial |
$8,513.72
|
| Rate for Payer: Humana KY Medicaid |
$3,444.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,479.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,213.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,391.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,004.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,513.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,814.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,512.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,012.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,911.14
|
| Rate for Payer: PHCS Commercial |
$9,615.49
|
| Rate for Payer: United Healthcare All Payer |
$8,814.20
|
|
|
CROSSLINK ANCHR PG GLENOD 52MM
|
Facility
|
IP
|
$9,617.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.39 |
| Max. Negotiated Rate |
$9,233.24 |
| Rate for Payer: Aetna Commercial |
$7,405.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,502.01
|
| Rate for Payer: Cash Price |
$4,808.98
|
| Rate for Payer: Cigna Commercial |
$7,982.91
|
| Rate for Payer: First Health Commercial |
$9,137.06
|
| Rate for Payer: Humana Commercial |
$8,175.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,886.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,098.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,885.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,463.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,213.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,367.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,636.39
|
| Rate for Payer: PHCS Commercial |
$9,233.24
|
| Rate for Payer: United Healthcare All Payer |
$8,463.80
|
|
|
CROSSLINK ANCHR PG GLENOD 52MM
|
Facility
|
OP
|
$9,617.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.39 |
| Max. Negotiated Rate |
$9,233.24 |
| Rate for Payer: Aetna Commercial |
$7,405.83
|
| Rate for Payer: Anthem Medicaid |
$3,307.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,502.01
|
| Rate for Payer: Cash Price |
$4,808.98
|
| Rate for Payer: Cigna Commercial |
$7,982.91
|
| Rate for Payer: First Health Commercial |
$9,137.06
|
| Rate for Payer: Humana Commercial |
$8,175.27
|
| Rate for Payer: Humana KY Medicaid |
$3,307.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,341.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,886.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,098.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,885.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,373.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,463.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,213.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,367.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,636.39
|
| Rate for Payer: PHCS Commercial |
$9,233.24
|
| Rate for Payer: United Healthcare All Payer |
$8,463.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56MM
|
Facility
|
OP
|
$9,617.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.39 |
| Max. Negotiated Rate |
$9,233.24 |
| Rate for Payer: Aetna Commercial |
$7,405.83
|
| Rate for Payer: Anthem Medicaid |
$3,307.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,502.01
|
| Rate for Payer: Cash Price |
$4,808.98
|
| Rate for Payer: Cigna Commercial |
$7,982.91
|
| Rate for Payer: First Health Commercial |
$9,137.06
|
| Rate for Payer: Humana Commercial |
$8,175.27
|
| Rate for Payer: Humana KY Medicaid |
$3,307.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,341.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,886.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,098.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,885.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,373.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,463.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,213.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,367.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,636.39
|
| Rate for Payer: PHCS Commercial |
$9,233.24
|
| Rate for Payer: United Healthcare All Payer |
$8,463.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56MM
|
Facility
|
IP
|
$9,617.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,885.39 |
| Max. Negotiated Rate |
$9,233.24 |
| Rate for Payer: Aetna Commercial |
$7,405.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,502.01
|
| Rate for Payer: Cash Price |
$4,808.98
|
| Rate for Payer: Cigna Commercial |
$7,982.91
|
| Rate for Payer: First Health Commercial |
$9,137.06
|
| Rate for Payer: Humana Commercial |
$8,175.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,886.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,098.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,885.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,463.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,213.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,367.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,636.39
|
| Rate for Payer: PHCS Commercial |
$9,233.24
|
| Rate for Payer: United Healthcare All Payer |
$8,463.80
|
|
|
CROSSLINK ANCHR PG GLENOD 56XL
|
Facility
|
IP
|
$8,429.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.70 |
| Max. Negotiated Rate |
$8,091.85 |
| Rate for Payer: Aetna Commercial |
$6,490.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.63
|
| Rate for Payer: Cash Price |
$4,214.50
|
| Rate for Payer: Cigna Commercial |
$6,996.08
|
| Rate for Payer: First Health Commercial |
$8,007.56
|
| Rate for Payer: Humana Commercial |
$7,164.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,911.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,321.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.02
|
| Rate for Payer: PHCS Commercial |
$8,091.85
|
| Rate for Payer: United Healthcare All Payer |
$7,417.53
|
|
|
CROSSLINK ANCHR PG GLENOD 56XL
|
Facility
|
OP
|
$8,429.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.70 |
| Max. Negotiated Rate |
$8,091.85 |
| Rate for Payer: Aetna Commercial |
$6,490.34
|
| Rate for Payer: Anthem Medicaid |
$2,898.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.63
|
| Rate for Payer: Cash Price |
$4,214.50
|
| Rate for Payer: Cigna Commercial |
$6,996.08
|
| Rate for Payer: First Health Commercial |
$8,007.56
|
| Rate for Payer: Humana Commercial |
$7,164.66
|
| Rate for Payer: Humana KY Medicaid |
$2,898.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,928.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,911.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,956.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,321.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.02
|
| Rate for Payer: PHCS Commercial |
$8,091.85
|
| Rate for Payer: United Healthcare All Payer |
$7,417.53
|
|
|
CROSSLINK FIN GLENOID 40MM
|
Facility
|
IP
|
$9,099.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,729.72 |
| Max. Negotiated Rate |
$8,735.12 |
| Rate for Payer: Aetna Commercial |
$7,006.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,097.28
|
| Rate for Payer: Cash Price |
$4,549.54
|
| Rate for Payer: Cigna Commercial |
$7,552.24
|
| Rate for Payer: First Health Commercial |
$8,644.13
|
| Rate for Payer: Humana Commercial |
$7,734.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,461.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,729.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,007.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,824.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,279.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,916.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,278.37
|
| Rate for Payer: PHCS Commercial |
$8,735.12
|
| Rate for Payer: United Healthcare All Payer |
$8,007.19
|
|
|
CROSSLINK FIN GLENOID 40MM
|
Facility
|
OP
|
$9,099.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,729.72 |
| Max. Negotiated Rate |
$8,735.12 |
| Rate for Payer: Aetna Commercial |
$7,006.29
|
| Rate for Payer: Anthem Medicaid |
$3,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,097.28
|
| Rate for Payer: Cash Price |
$4,549.54
|
| Rate for Payer: Cigna Commercial |
$7,552.24
|
| Rate for Payer: First Health Commercial |
$8,644.13
|
| Rate for Payer: Humana Commercial |
$7,734.22
|
| Rate for Payer: Humana KY Medicaid |
$3,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,161.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,461.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,729.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,191.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,007.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,824.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,279.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,916.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,278.37
|
| Rate for Payer: PHCS Commercial |
$8,735.12
|
| Rate for Payer: United Healthcare All Payer |
$8,007.19
|
|
|
CROSSLINK FIN GLENOID 40XS
|
Facility
|
IP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
CROSSLINK FIN GLENOID 40XS
|
Facility
|
OP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem Medicaid |
$2,507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Humana KY Medicaid |
$2,507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
CROSSLINK FIN GLENOID 44MM
|
Facility
|
IP
|
$9,099.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,729.72 |
| Max. Negotiated Rate |
$8,735.12 |
| Rate for Payer: Aetna Commercial |
$7,006.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,097.28
|
| Rate for Payer: Cash Price |
$4,549.54
|
| Rate for Payer: Cigna Commercial |
$7,552.24
|
| Rate for Payer: First Health Commercial |
$8,644.13
|
| Rate for Payer: Humana Commercial |
$7,734.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,461.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,729.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,007.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,824.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,279.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,916.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,278.37
|
| Rate for Payer: PHCS Commercial |
$8,735.12
|
| Rate for Payer: United Healthcare All Payer |
$8,007.19
|
|
|
CROSSLINK FIN GLENOID 44MM
|
Facility
|
OP
|
$9,099.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,729.72 |
| Max. Negotiated Rate |
$8,735.12 |
| Rate for Payer: Aetna Commercial |
$7,006.29
|
| Rate for Payer: Anthem Medicaid |
$3,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,097.28
|
| Rate for Payer: Cash Price |
$4,549.54
|
| Rate for Payer: Cigna Commercial |
$7,552.24
|
| Rate for Payer: First Health Commercial |
$8,644.13
|
| Rate for Payer: Humana Commercial |
$7,734.22
|
| Rate for Payer: Humana KY Medicaid |
$3,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,161.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,461.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,729.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,191.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,007.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,824.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,279.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,916.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,278.37
|
| Rate for Payer: PHCS Commercial |
$8,735.12
|
| Rate for Payer: United Healthcare All Payer |
$8,007.19
|
|
