|
SCORPIO TS FULL TIBIAL WDG #13
|
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 #13
|
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
|
|
|
SCORPIO TS FULL TIBIAL WDGE #3
|
Facility
|
IP
|
$7,434.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.43 |
| Max. Negotiated Rate |
$7,136.68 |
| Rate for Payer: Aetna Commercial |
$5,724.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,798.55
|
| Rate for Payer: Cash Price |
$3,717.02
|
| Rate for Payer: Cigna Commercial |
$6,170.25
|
| Rate for Payer: First Health Commercial |
$7,062.34
|
| Rate for Payer: Humana Commercial |
$6,318.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,095.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,486.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,230.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,541.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,575.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$966.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.55
|
| Rate for Payer: PHCS Commercial |
$7,136.68
|
| Rate for Payer: United Healthcare All Payer |
$6,541.96
|
|
|
SCORPIO TS FULL TIBIAL WDGE #3
|
Facility
|
OP
|
$7,434.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.43 |
| Max. Negotiated Rate |
$7,136.68 |
| Rate for Payer: Aetna Commercial |
$5,724.21
|
| Rate for Payer: Anthem Medicaid |
$2,556.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,798.55
|
| Rate for Payer: Cash Price |
$3,717.02
|
| Rate for Payer: Cigna Commercial |
$6,170.25
|
| Rate for Payer: First Health Commercial |
$7,062.34
|
| Rate for Payer: Humana Commercial |
$6,318.93
|
| Rate for Payer: Humana KY Medicaid |
$2,556.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,582.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,095.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,486.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,230.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,607.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,541.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,575.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$966.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.55
|
| Rate for Payer: PHCS Commercial |
$7,136.68
|
| Rate for Payer: United Healthcare All Payer |
$6,541.96
|
|
|
SCORPIO TS FULL TIBIAL WDGE #5
|
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
|
|
|
SCORPIO TS FULL TIBIAL WDGE #5
|
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 WDGE #7
|
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
|
|
|
SCORPIO TS FULL TIBIAL WDGE #7
|
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 WDGE #9
|
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 WDGE #9
|
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
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem Medicaid |
$445.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Humana KY Medicaid |
$445.01
|
| Rate for Payer: Kentucky WC Medicaid |
$449.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
OP
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.74 |
| Max. Negotiated Rate |
$2,324.24 |
| Rate for Payer: Aetna Commercial |
$1,864.23
|
| Rate for Payer: Anthem Medicaid |
$832.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,888.44
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$2,009.50
|
| Rate for Payer: First Health Commercial |
$2,300.03
|
| Rate for Payer: Humana Commercial |
$2,057.92
|
| Rate for Payer: Humana KY Medicaid |
$832.61
|
| Rate for Payer: Kentucky WC Medicaid |
$841.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,985.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,786.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,130.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.53
|
| Rate for Payer: PHCS Commercial |
$2,324.24
|
| Rate for Payer: United Healthcare All Payer |
$2,130.55
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Professional
|
Both
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$2,421.08 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,421.08
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$83.10
|
| Rate for Payer: Healthspan PPO |
$299.12
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$1,452.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,694.76
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
IP
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.74 |
| Max. Negotiated Rate |
$2,324.24 |
| Rate for Payer: Aetna Commercial |
$1,864.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,888.44
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$2,009.50
|
| Rate for Payer: First Health Commercial |
$2,300.03
|
| Rate for Payer: Humana Commercial |
$2,057.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,985.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,786.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,130.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.53
|
| Rate for Payer: PHCS Commercial |
$2,324.24
|
| Rate for Payer: United Healthcare All Payer |
$2,130.55
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(P
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761P1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$451.00 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$451.00
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$83.10
|
| Rate for Payer: Healthspan PPO |
$299.12
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$270.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.70
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(T
|
Facility
|
OP
|
$1,970.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761T1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.11 |
| Max. Negotiated Rate |
$1,891.28 |
| Rate for Payer: Aetna Commercial |
$1,516.96
|
| Rate for Payer: Anthem Medicaid |
$677.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.66
|
| Rate for Payer: Cash Price |
$985.04
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: First Health Commercial |
$1,871.58
|
| Rate for Payer: Humana Commercial |
$1,674.57
|
| Rate for Payer: Humana KY Medicaid |
$677.51
|
| Rate for Payer: Kentucky WC Medicaid |
$684.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.72
|
| Rate for Payer: PHCS Commercial |
$1,891.28
|
| Rate for Payer: United Healthcare All Payer |
$1,733.67
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(T
|
Facility
|
IP
|
$1,970.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761T1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.11 |
| Max. Negotiated Rate |
$1,891.28 |
| Rate for Payer: Aetna Commercial |
$1,516.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.66
|
| Rate for Payer: Cash Price |
$985.04
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: First Health Commercial |
$1,871.58
|
| Rate for Payer: Humana Commercial |
$1,674.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.72
|
| Rate for Payer: PHCS Commercial |
$1,891.28
|
| Rate for Payer: United Healthcare All Payer |
$1,733.67
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
IP
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.79 |
| Max. Negotiated Rate |
$6,031.68 |
| Rate for Payer: Aetna Commercial |
$4,837.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,900.74
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$5,214.89
|
| Rate for Payer: First Health Commercial |
$5,968.85
|
| Rate for Payer: Humana Commercial |
$5,340.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,152.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,636.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,884.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,529.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$816.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,947.73
|
| Rate for Payer: PHCS Commercial |
$6,031.68
|
| Rate for Payer: United Healthcare All Payer |
$5,529.04
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Professional
|
Both
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.58 |
| Max. Negotiated Rate |
$6,283.00 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.58
|
| Rate for Payer: Anthem Medicaid |
$297.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,283.00
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$520.39
|
| Rate for Payer: Healthspan PPO |
$3,147.09
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
| Rate for Payer: Molina Healthcare Passport |
$297.78
|
| Rate for Payer: Multiplan PHCS |
$3,769.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,398.10
|
| Rate for Payer: UHCCP Medicaid |
$236.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
OP
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.79 |
| Max. Negotiated Rate |
$6,031.68 |
| Rate for Payer: Aetna Commercial |
$4,837.91
|
| Rate for Payer: Anthem Medicaid |
$2,160.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,900.74
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$5,214.89
|
| Rate for Payer: First Health Commercial |
$5,968.85
|
| Rate for Payer: Humana Commercial |
$5,340.55
|
| Rate for Payer: Humana KY Medicaid |
$2,160.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,182.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,152.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,636.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,884.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,204.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,529.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$816.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,947.73
|
| Rate for Payer: PHCS Commercial |
$6,031.68
|
| Rate for Payer: United Healthcare All Payer |
$5,529.04
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem Medicaid |
$445.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Humana KY Medicaid |
$445.01
|
| Rate for Payer: Kentucky WC Medicaid |
$449.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP ART INI 3RD> BRACH THOR(P
|
Professional
|
Both
|
$3,141.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761P1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.58 |
| Max. Negotiated Rate |
$3,147.09 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.58
|
| Rate for Payer: Anthem Medicaid |
$297.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,141.00
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$520.39
|
| Rate for Payer: Healthspan PPO |
$3,147.09
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
| Rate for Payer: Molina Healthcare Passport |
$297.78
|
| Rate for Payer: Multiplan PHCS |
$1,884.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,198.70
|
| Rate for Payer: UHCCP Medicaid |
$236.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
|
|
SCP ART INI 3RD> BRACH THOR(T
|
Facility
|
OP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761T1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.46 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem Medicaid |
$1,080.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Humana KY Medicaid |
$1,080.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,091.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.02
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
