|
SCORPIO PAT MED DOME SZ 7 10MM
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
SCORPIO PAT MED DOME SZ 7 10MM
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.56 |
| Max. Negotiated Rate |
$4,235.52 |
| Rate for Payer: Aetna Commercial |
$3,397.24
|
| Rate for Payer: Anthem Medicaid |
$1,517.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,441.36
|
| Rate for Payer: Cash Price |
$2,206.00
|
| Rate for Payer: Cigna Commercial |
$3,661.96
|
| Rate for Payer: First Health Commercial |
$4,191.40
|
| Rate for Payer: Humana Commercial |
$3,750.20
|
| Rate for Payer: Humana KY Medicaid |
$1,517.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,256.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,882.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.72
|
| Rate for Payer: PHCS Commercial |
$4,235.52
|
| Rate for Payer: United Healthcare All Payer |
$3,882.56
|
|
|
SCORPIO PAT MED DOME SZ 9 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 9 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
|
|
|
SCORPIO P/S FEMORAL SZ 11 LT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 11 LT
|
Facility
|
IP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 11 RT
|
Facility
|
IP
|
$12,752.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.77 |
| Max. Negotiated Rate |
$12,241.96 |
| Rate for Payer: Aetna Commercial |
$9,819.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,946.59
|
| Rate for Payer: Cash Price |
$6,376.02
|
| Rate for Payer: Cigna Commercial |
$10,584.19
|
| Rate for Payer: First Health Commercial |
$12,114.44
|
| Rate for Payer: Humana Commercial |
$10,839.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,456.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,411.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,825.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,564.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,953.13
|
| Rate for Payer: PHCS Commercial |
$12,241.96
|
| Rate for Payer: United Healthcare All Payer |
$11,221.80
|
|
|
SCORPIO P/S FEMORAL SZ 11 RT
|
Facility
|
OP
|
$12,752.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.77 |
| Max. Negotiated Rate |
$12,241.96 |
| Rate for Payer: Aetna Commercial |
$9,819.07
|
| Rate for Payer: Anthem Medicaid |
$4,385.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,946.59
|
| Rate for Payer: Cash Price |
$6,376.02
|
| Rate for Payer: Cigna Commercial |
$10,584.19
|
| Rate for Payer: First Health Commercial |
$12,114.44
|
| Rate for Payer: Humana Commercial |
$10,839.23
|
| Rate for Payer: Humana KY Medicaid |
$4,385.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,430.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,456.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,411.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,825.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,473.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,564.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,953.13
|
| Rate for Payer: PHCS Commercial |
$12,241.96
|
| Rate for Payer: United Healthcare All Payer |
$11,221.80
|
|
|
SCORPIO P/S FEMORAL SZ 13 LT
|
Facility
|
OP
|
$10,921.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.76 |
| Max. Negotiated Rate |
$10,484.35 |
| Rate for Payer: Aetna Commercial |
$8,409.32
|
| Rate for Payer: Anthem Medicaid |
$3,755.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,518.54
|
| Rate for Payer: Cash Price |
$5,460.60
|
| Rate for Payer: Cigna Commercial |
$9,064.60
|
| Rate for Payer: First Health Commercial |
$10,375.14
|
| Rate for Payer: Humana Commercial |
$9,283.02
|
| Rate for Payer: Humana KY Medicaid |
$3,755.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,794.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,955.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,059.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,276.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,831.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,610.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,190.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,419.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.57
|
| Rate for Payer: PHCS Commercial |
$10,484.35
|
| Rate for Payer: United Healthcare All Payer |
$9,610.66
|
|
|
SCORPIO P/S FEMORAL SZ 13 LT
|
Facility
|
IP
|
$10,921.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.76 |
| Max. Negotiated Rate |
$10,484.35 |
| Rate for Payer: Aetna Commercial |
$8,409.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,518.54
|
| Rate for Payer: Cash Price |
$5,460.60
|
| Rate for Payer: Cigna Commercial |
$9,064.60
|
| Rate for Payer: First Health Commercial |
$10,375.14
|
| Rate for Payer: Humana Commercial |
$9,283.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,955.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,059.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,276.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,610.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,190.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,419.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.57
|
| Rate for Payer: PHCS Commercial |
$10,484.35
|
| Rate for Payer: United Healthcare All Payer |
$9,610.66
|
|
|
SCORPIO P/S FEMORAL SZ 13 RT
|
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 P/S FEMORAL SZ 13 RT
|
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 P/S FEMORAL SZ 3 LT
|
Facility
|
OP
|
$11,429.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,485.81 |
| Max. Negotiated Rate |
$10,972.11 |
| Rate for Payer: Aetna Commercial |
$8,800.55
|
| Rate for Payer: Anthem Medicaid |
$3,930.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,914.84
|
| Rate for Payer: Cash Price |
$5,714.64
|
| Rate for Payer: Cigna Commercial |
$9,486.30
|
| Rate for Payer: First Health Commercial |
$10,857.82
|
| Rate for Payer: Humana Commercial |
$9,714.89
|
| Rate for Payer: Humana KY Medicaid |
$3,930.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,970.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,372.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,434.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,009.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,057.77
|
| Rate for Payer: Ohio Health Group HMO |
$8,571.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,285.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.08
|
| Rate for Payer: PHCS Commercial |
$10,972.11
|
| Rate for Payer: United Healthcare All Payer |
$10,057.77
|
|
|
SCORPIO P/S FEMORAL SZ 3 LT
|
Facility
|
IP
|
$11,429.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,485.81 |
| Max. Negotiated Rate |
$10,972.11 |
| Rate for Payer: Aetna Commercial |
$8,800.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,914.84
|
| Rate for Payer: Cash Price |
$5,714.64
|
| Rate for Payer: Cigna Commercial |
$9,486.30
|
| Rate for Payer: First Health Commercial |
$10,857.82
|
| Rate for Payer: Humana Commercial |
$9,714.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,372.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,434.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,057.77
|
| Rate for Payer: Ohio Health Group HMO |
$8,571.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,285.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,543.08
|
| Rate for Payer: PHCS Commercial |
$10,972.11
|
| Rate for Payer: United Healthcare All Payer |
$10,057.77
|
|
|
SCORPIO P/S FEMORAL SZ 5 LT
|
Facility
|
OP
|
$12,752.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.77 |
| Max. Negotiated Rate |
$12,241.96 |
| Rate for Payer: Aetna Commercial |
$9,819.07
|
| Rate for Payer: Anthem Medicaid |
$4,385.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,946.59
|
| Rate for Payer: Cash Price |
$6,376.02
|
| Rate for Payer: Cigna Commercial |
$10,584.19
|
| Rate for Payer: First Health Commercial |
$12,114.44
|
| Rate for Payer: Humana Commercial |
$10,839.23
|
| Rate for Payer: Humana KY Medicaid |
$4,385.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,430.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,456.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,411.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,825.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,473.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,564.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,953.13
|
| Rate for Payer: PHCS Commercial |
$12,241.96
|
| Rate for Payer: United Healthcare All Payer |
$11,221.80
|
|
|
SCORPIO P/S FEMORAL SZ 5 LT
|
Facility
|
IP
|
$12,752.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.77 |
| Max. Negotiated Rate |
$12,241.96 |
| Rate for Payer: Aetna Commercial |
$9,819.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,946.59
|
| Rate for Payer: Cash Price |
$6,376.02
|
| Rate for Payer: Cigna Commercial |
$10,584.19
|
| Rate for Payer: First Health Commercial |
$12,114.44
|
| Rate for Payer: Humana Commercial |
$10,839.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,456.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,411.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,825.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,564.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,953.13
|
| Rate for Payer: PHCS Commercial |
$12,241.96
|
| Rate for Payer: United Healthcare All Payer |
$11,221.80
|
|
|
SCORPIO P/S FEMORAL SZ 5 RT
|
Facility
|
IP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 5 RT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 7 LT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 7 LT
|
Facility
|
IP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 7 RT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 7 RT
|
Facility
|
IP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 9 LT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 9 LT
|
Facility
|
IP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
|
SCORPIO P/S FEMORAL SZ 9 RT
|
Facility
|
OP
|
$13,225.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.26 |
| Max. Negotiated Rate |
$12,696.08 |
| Rate for Payer: Aetna Commercial |
$10,183.31
|
| Rate for Payer: Anthem Medicaid |
$4,548.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,315.56
|
| Rate for Payer: Cash Price |
$6,612.54
|
| Rate for Payer: Cigna Commercial |
$10,976.82
|
| Rate for Payer: First Health Commercial |
$12,563.83
|
| Rate for Payer: Humana Commercial |
$11,241.32
|
| Rate for Payer: Humana KY Medicaid |
$4,548.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,594.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,760.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,967.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,639.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,638.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,719.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.77
|
| Rate for Payer: PHCS Commercial |
$12,696.08
|
| Rate for Payer: United Healthcare All Payer |
$11,638.07
|
|
