|
CROSSLINK FIN GLENOID 48MM
|
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 48MM
|
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 52MM
|
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 52MM
|
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 56MM
|
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 56MM
|
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 56XL
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
CROSSLINK FIN GLENOID 56XL
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
CROSSTELLA OTW 2*100*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*100*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*120*150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSSTELLA OTW 2*120*150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CROSSTELLA OTW 2*150*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*150*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*200*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*200*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*20*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*20*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*40*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*40*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*50*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2*50*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2.5*100*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2.5*100*150
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
CROSSTELLA OTW 2.5*120*150
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
