|
SCOREFLEX NC SCORING 4 X 20
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
SCORPIO CR FEM COMP #7 R LFIT
|
Facility
|
IP
|
$16,526.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.43 |
| Max. Negotiated Rate |
$15,865.34 |
| Rate for Payer: Aetna Commercial |
$12,725.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,890.59
|
| Rate for Payer: Cash Price |
$8,263.20
|
| Rate for Payer: Cigna Commercial |
$13,716.91
|
| Rate for Payer: First Health Commercial |
$15,700.08
|
| Rate for Payer: Humana Commercial |
$14,047.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,551.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,957.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,543.23
|
| Rate for Payer: Ohio Health Group HMO |
$12,394.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,123.18
|
| Rate for Payer: PHCS Commercial |
$15,865.34
|
| Rate for Payer: United Healthcare All Payer |
$14,543.23
|
|
|
SCORPIO CR FEM COMP #7 R LFIT
|
Facility
|
OP
|
$16,526.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.43 |
| Max. Negotiated Rate |
$15,865.34 |
| Rate for Payer: Aetna Commercial |
$12,725.33
|
| Rate for Payer: Anthem Medicaid |
$5,683.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,890.59
|
| Rate for Payer: Cash Price |
$8,263.20
|
| Rate for Payer: Cigna Commercial |
$13,716.91
|
| Rate for Payer: First Health Commercial |
$15,700.08
|
| Rate for Payer: Humana Commercial |
$14,047.44
|
| Rate for Payer: Humana KY Medicaid |
$5,683.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,551.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,957.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,797.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,543.23
|
| Rate for Payer: Ohio Health Group HMO |
$12,394.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,123.18
|
| Rate for Payer: PHCS Commercial |
$15,865.34
|
| Rate for Payer: United Healthcare All Payer |
$14,543.23
|
|
|
SCORPIO CR FEMORAL COMP #13 L
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
SCORPIO CR FEMORAL COMP #13 L
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem Medicaid |
$4,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Humana KY Medicaid |
$4,473.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,519.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
SCORPIO CR FEMORAL COMP #7 L
|
Facility
|
IP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO CR FEMORAL COMP #7 L
|
Facility
|
OP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem Medicaid |
$4,414.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Humana KY Medicaid |
$4,414.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,459.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,503.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO CR FEMORAL COMP #7 R
|
Facility
|
IP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO CR FEMORAL COMP #7 R
|
Facility
|
OP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem Medicaid |
$4,414.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Humana KY Medicaid |
$4,414.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,459.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,503.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO CR FEMORAL COMP #9 L
|
Facility
|
OP
|
$12,381.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.56 |
| Max. Negotiated Rate |
$11,885.95 |
| Rate for Payer: Aetna Commercial |
$9,533.52
|
| Rate for Payer: Anthem Medicaid |
$4,257.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.34
|
| Rate for Payer: Cash Price |
$6,190.60
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: First Health Commercial |
$11,762.14
|
| Rate for Payer: Humana Commercial |
$10,524.02
|
| Rate for Payer: Humana KY Medicaid |
$4,257.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,301.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.46
|
| Rate for Payer: Ohio Health Group HMO |
$9,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.17
|
| Rate for Payer: PHCS Commercial |
$11,885.95
|
| Rate for Payer: United Healthcare All Payer |
$10,895.46
|
|
|
SCORPIO CR FEMORAL COMP #9 L
|
Facility
|
IP
|
$12,381.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.56 |
| Max. Negotiated Rate |
$11,885.95 |
| Rate for Payer: Aetna Commercial |
$9,533.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.34
|
| Rate for Payer: Cash Price |
$6,190.60
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: First Health Commercial |
$11,762.14
|
| Rate for Payer: Humana Commercial |
$10,524.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.46
|
| Rate for Payer: Ohio Health Group HMO |
$9,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.17
|
| Rate for Payer: PHCS Commercial |
$11,885.95
|
| Rate for Payer: United Healthcare All Payer |
$10,895.46
|
|
|
SCORPIO CR INSERT #11/13 15MM
|
Facility
|
IP
|
$5,215.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$5,006.98 |
| Rate for Payer: Aetna Commercial |
$4,016.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,068.17
|
| Rate for Payer: Cash Price |
$2,607.80
|
| Rate for Payer: Cigna Commercial |
$4,328.95
|
| Rate for Payer: First Health Commercial |
$4,954.82
|
| Rate for Payer: Humana Commercial |
$4,433.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,276.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,849.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,589.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,911.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,043.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,616.84
|
| Rate for Payer: PHCS Commercial |
$5,006.98
|
| Rate for Payer: United Healthcare All Payer |
$4,589.73
|
|
|
SCORPIO CR INSERT #11/13 15MM
|
Facility
|
OP
|
$5,215.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$5,006.98 |
| Rate for Payer: Aetna Commercial |
$4,016.01
|
| Rate for Payer: Anthem Medicaid |
$1,793.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,068.17
|
| Rate for Payer: Cash Price |
$2,607.80
|
| Rate for Payer: Cigna Commercial |
$4,328.95
|
| Rate for Payer: First Health Commercial |
$4,954.82
|
| Rate for Payer: Humana Commercial |
$4,433.26
|
| Rate for Payer: Humana KY Medicaid |
$1,793.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,811.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,276.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,849.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,829.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,589.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,911.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,043.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,616.84
|
| Rate for Payer: PHCS Commercial |
$5,006.98
|
| Rate for Payer: United Healthcare All Payer |
$4,589.73
|
|
|
SCORPIO FEMORAL COMP #9 R
|
Facility
|
IP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO FEMORAL COMP #9 R
|
Facility
|
OP
|
$12,836.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.77 |
| Max. Negotiated Rate |
$12,323.25 |
| Rate for Payer: Aetna Commercial |
$9,884.27
|
| Rate for Payer: Anthem Medicaid |
$4,414.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,012.64
|
| Rate for Payer: Cash Price |
$6,418.36
|
| Rate for Payer: Cigna Commercial |
$10,654.48
|
| Rate for Payer: First Health Commercial |
$12,194.88
|
| Rate for Payer: Humana Commercial |
$10,911.21
|
| Rate for Payer: Humana KY Medicaid |
$4,414.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,459.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,526.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,473.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,851.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,503.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,296.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,627.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,567.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,668.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,979.38
|
| Rate for Payer: PHCS Commercial |
$12,323.25
|
| Rate for Payer: United Healthcare All Payer |
$11,296.31
|
|
|
SCORPIO PATELLA DOME #3/8MM
|
Facility
|
OP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem Medicaid |
$1,548.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Humana KY Medicaid |
$1,548.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PATELLA DOME #3/8MM
|
Facility
|
IP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PATELLA DOME #5/8MM
|
Facility
|
OP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem Medicaid |
$1,548.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Humana KY Medicaid |
$1,548.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PATELLA DOME #5/8MM
|
Facility
|
IP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PATELLA DOME #7/8MM
|
Facility
|
IP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PATELLA DOME #7/8MM
|
Facility
|
OP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem Medicaid |
$1,548.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Humana KY Medicaid |
$1,548.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PAT MED DOME SZ 11 10M
|
Facility
|
IP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PAT MED DOME SZ 11 10M
|
Facility
|
OP
|
$4,501.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.21 |
| Max. Negotiated Rate |
$4,321.54 |
| Rate for Payer: Aetna Commercial |
$3,466.23
|
| Rate for Payer: Anthem Medicaid |
$1,548.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.25
|
| Rate for Payer: Cash Price |
$2,250.80
|
| Rate for Payer: Cigna Commercial |
$3,736.33
|
| Rate for Payer: First Health Commercial |
$4,276.52
|
| Rate for Payer: Humana Commercial |
$3,826.36
|
| Rate for Payer: Humana KY Medicaid |
$1,548.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.50
|
| Rate for Payer: PHCS Commercial |
$4,321.54
|
| Rate for Payer: United Healthcare All Payer |
$3,961.41
|
|
|
SCORPIO PAT MED DOME SZ 5 10MM
|
Facility
|
OP
|
$4,560.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.85 |
| Max. Negotiated Rate |
$4,377.98 |
| Rate for Payer: Aetna Commercial |
$3,511.51
|
| Rate for Payer: Anthem Medicaid |
$1,568.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,557.11
|
| Rate for Payer: Cash Price |
$2,280.20
|
| Rate for Payer: Cigna Commercial |
$3,785.13
|
| Rate for Payer: First Health Commercial |
$4,332.38
|
| Rate for Payer: Humana Commercial |
$3,876.34
|
| Rate for Payer: Humana KY Medicaid |
$1,568.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,584.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,739.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,365.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,599.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,013.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,420.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.72
|
| Rate for Payer: PHCS Commercial |
$4,377.98
|
| Rate for Payer: United Healthcare All Payer |
$4,013.15
|
|
|
SCORPIO PAT MED DOME SZ 5 10MM
|
Facility
|
IP
|
$4,560.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.85 |
| Max. Negotiated Rate |
$4,377.98 |
| Rate for Payer: Aetna Commercial |
$3,511.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,557.11
|
| Rate for Payer: Cash Price |
$2,280.20
|
| Rate for Payer: Cigna Commercial |
$3,785.13
|
| Rate for Payer: First Health Commercial |
$4,332.38
|
| Rate for Payer: Humana Commercial |
$3,876.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,739.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,365.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,013.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,420.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.72
|
| Rate for Payer: PHCS Commercial |
$4,377.98
|
| Rate for Payer: United Healthcare All Payer |
$4,013.15
|
|
