|
SCORPIO P/S FEMORAL SZ 9 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 TIBIAL INST SZ 3
|
Facility
|
IP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
SCORPIO P/S TIBIAL INST SZ 3
|
Facility
|
OP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem Medicaid |
$1,687.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Humana KY Medicaid |
$1,687.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
SCORPIO TIBIAL BASE SZ 11
|
Facility
|
OP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem Medicaid |
$2,979.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Humana KY Medicaid |
$2,979.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,009.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 11
|
Facility
|
IP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 13
|
Facility
|
IP
|
$8,491.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.84 |
| Max. Negotiated Rate |
$8,151.44 |
| Rate for Payer: Aetna Commercial |
$6,538.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,623.04
|
| Rate for Payer: Cash Price |
$4,245.54
|
| Rate for Payer: Cigna Commercial |
$7,047.60
|
| Rate for Payer: First Health Commercial |
$8,066.53
|
| Rate for Payer: Humana Commercial |
$7,217.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,962.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,472.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,368.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.23
|
| Rate for Payer: PHCS Commercial |
$8,151.44
|
| Rate for Payer: United Healthcare All Payer |
$7,472.15
|
|
|
SCORPIO TIBIAL BASE SZ 13
|
Facility
|
OP
|
$8,491.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.84 |
| Max. Negotiated Rate |
$8,151.44 |
| Rate for Payer: Aetna Commercial |
$6,538.13
|
| Rate for Payer: Anthem Medicaid |
$2,920.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,623.04
|
| Rate for Payer: Cash Price |
$4,245.54
|
| Rate for Payer: Cigna Commercial |
$7,047.60
|
| Rate for Payer: First Health Commercial |
$8,066.53
|
| Rate for Payer: Humana Commercial |
$7,217.42
|
| Rate for Payer: Humana KY Medicaid |
$2,920.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,949.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,962.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,978.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,472.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,368.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.23
|
| Rate for Payer: PHCS Commercial |
$8,151.44
|
| Rate for Payer: United Healthcare All Payer |
$7,472.15
|
|
|
SCORPIO TIBIAL BASE SZ 3
|
Facility
|
IP
|
$8,491.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.84 |
| Max. Negotiated Rate |
$8,151.44 |
| Rate for Payer: Aetna Commercial |
$6,538.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,623.04
|
| Rate for Payer: Cash Price |
$4,245.54
|
| Rate for Payer: Cigna Commercial |
$7,047.60
|
| Rate for Payer: First Health Commercial |
$8,066.53
|
| Rate for Payer: Humana Commercial |
$7,217.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,962.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,472.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,368.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.23
|
| Rate for Payer: PHCS Commercial |
$8,151.44
|
| Rate for Payer: United Healthcare All Payer |
$7,472.15
|
|
|
SCORPIO TIBIAL BASE SZ 3
|
Facility
|
OP
|
$8,491.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.84 |
| Max. Negotiated Rate |
$8,151.44 |
| Rate for Payer: Aetna Commercial |
$6,538.13
|
| Rate for Payer: Anthem Medicaid |
$2,920.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,623.04
|
| Rate for Payer: Cash Price |
$4,245.54
|
| Rate for Payer: Cigna Commercial |
$7,047.60
|
| Rate for Payer: First Health Commercial |
$8,066.53
|
| Rate for Payer: Humana Commercial |
$7,217.42
|
| Rate for Payer: Humana KY Medicaid |
$2,920.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,949.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,962.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,978.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,472.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,368.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.23
|
| Rate for Payer: PHCS Commercial |
$8,151.44
|
| Rate for Payer: United Healthcare All Payer |
$7,472.15
|
|
|
SCORPIO TIBIAL BASE SZ 5
|
Facility
|
IP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 5
|
Facility
|
OP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem Medicaid |
$2,979.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Humana KY Medicaid |
$2,979.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,009.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 7
|
Facility
|
OP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem Medicaid |
$2,979.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Humana KY Medicaid |
$2,979.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,009.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 7
|
Facility
|
IP
|
$8,663.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.24 |
| Max. Negotiated Rate |
$8,316.83 |
| Rate for Payer: Aetna Commercial |
$6,670.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,757.42
|
| Rate for Payer: Cash Price |
$4,331.68
|
| Rate for Payer: Cigna Commercial |
$7,190.59
|
| Rate for Payer: First Health Commercial |
$8,230.19
|
| Rate for Payer: Humana Commercial |
$7,363.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,103.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,393.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,497.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.64
|
| Rate for Payer: PHCS Commercial |
$8,316.83
|
| Rate for Payer: United Healthcare All Payer |
$7,623.76
|
|
|
SCORPIO TIBIAL BASE SZ 9
|
Facility
|
OP
|
$8,383.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.80 |
| Max. Negotiated Rate |
$8,047.72 |
| Rate for Payer: Aetna Commercial |
$6,454.94
|
| Rate for Payer: Anthem Medicaid |
$2,882.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,538.77
|
| Rate for Payer: Cash Price |
$4,191.52
|
| Rate for Payer: Cigna Commercial |
$6,957.92
|
| Rate for Payer: First Health Commercial |
$7,963.89
|
| Rate for Payer: Humana Commercial |
$7,125.58
|
| Rate for Payer: Humana KY Medicaid |
$2,882.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,874.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,186.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,940.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,377.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,287.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,598.74
|
| Rate for Payer: PHCS Commercial |
$8,047.72
|
| Rate for Payer: United Healthcare All Payer |
$7,377.08
|
|
|
SCORPIO TIBIAL BASE SZ 9
|
Facility
|
IP
|
$8,383.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.80 |
| Max. Negotiated Rate |
$8,047.72 |
| Rate for Payer: Aetna Commercial |
$6,454.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,538.77
|
| Rate for Payer: Cash Price |
$4,191.52
|
| Rate for Payer: Cigna Commercial |
$6,957.92
|
| Rate for Payer: First Health Commercial |
$7,963.89
|
| Rate for Payer: Humana Commercial |
$7,125.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,874.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,186.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,514.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,377.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,287.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,598.74
|
| Rate for Payer: PHCS Commercial |
$8,047.72
|
| Rate for Payer: United Healthcare All Payer |
$7,377.08
|
|
|
SCORPIO TIBIAL INST CR 15MM #7
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIBIAL INST CR 15MM #7
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 7 15MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 7 15MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 7 8MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 7 8MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 8 11/13
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TIB INSERT SZ 8 11/13
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
SCORPIO TS FULL TIBIAL WDG #11
|
Facility
|
IP
|
$7,215.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.96 |
| Max. Negotiated Rate |
$6,926.44 |
| Rate for Payer: Aetna Commercial |
$5,555.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,627.73
|
| Rate for Payer: Cash Price |
$3,607.52
|
| Rate for Payer: Cigna Commercial |
$5,988.48
|
| Rate for Payer: First Health Commercial |
$6,854.29
|
| Rate for Payer: Humana Commercial |
$6,132.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,324.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.66
|
| Rate for Payer: PHCS Commercial |
$6,926.44
|
| Rate for Payer: United Healthcare All Payer |
$6,349.24
|
|
|
SCORPIO TS FULL TIBIAL WDG #11
|
Facility
|
OP
|
$7,215.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.96 |
| Max. Negotiated Rate |
$6,926.44 |
| Rate for Payer: Aetna Commercial |
$5,555.58
|
| Rate for Payer: Anthem Medicaid |
$2,481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,627.73
|
| Rate for Payer: Cash Price |
$3,607.52
|
| Rate for Payer: Cigna Commercial |
$5,988.48
|
| Rate for Payer: First Health Commercial |
$6,854.29
|
| Rate for Payer: Humana Commercial |
$6,132.78
|
| Rate for Payer: Humana KY Medicaid |
$2,481.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,324.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.66
|
| Rate for Payer: PHCS Commercial |
$6,926.44
|
| Rate for Payer: United Healthcare All Payer |
$6,349.24
|
|
