|
SCLEROTHERAPY SPIDER VEINS
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
76101460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
SCLEROTHERAPY SPIDER VEINS
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
76101460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$549.50 |
| Rate for Payer: Aetna Commercial |
$108.86
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.04
|
| Rate for Payer: Multiplan PHCS |
$471.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.50
|
| Rate for Payer: UHCCP Medicaid |
$274.75
|
|
|
SCLEROTHERAPY SPIDER VEINS(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
761P1460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$108.86
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.04
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
SCLEROTHERAPY SPIDER VEINS(T
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
761T1460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem Medicaid |
$201.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Humana KY Medicaid |
$201.18
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$203.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.65
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
SCLEROTHERAPY SPIDER VEINS(T
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
761T1460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.65
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
SCLEROTX FLUID COLLECTION
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
76102943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
SCLEROTX FLUID COLLECTION
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
76102943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Ambetter Exchange |
$112.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.97
|
| Rate for Payer: Anthem Medicaid |
$738.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$134.63
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Humana Medicaid |
$738.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$173.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.52
|
| Rate for Payer: Molina Healthcare Passport |
$738.75
|
| Rate for Payer: Multiplan PHCS |
$1,812.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.85
|
| Rate for Payer: UHCCP Medicaid |
$104.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.19
|
|
|
SCLEROTX FLUID COLLECTION
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
76102943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,038.58 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem Medicaid |
$1,038.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Humana KY Medicaid |
$1,038.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,059.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
SCLEROTX FLUID COLLECTION (P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
761P2943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$753.52 |
| Rate for Payer: Ambetter Exchange |
$112.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.97
|
| Rate for Payer: Anthem Medicaid |
$738.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$134.63
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Humana Medicaid |
$738.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$173.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.52
|
| Rate for Payer: Molina Healthcare Passport |
$738.75
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.85
|
| Rate for Payer: UHCCP Medicaid |
$104.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.19
|
|
|
SCLEROTX FLUID COLLECTION (T
|
Facility
|
OP
|
$2,745.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
761T2943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.01 |
| Max. Negotiated Rate |
$2,635.20 |
| Rate for Payer: Aetna Commercial |
$2,113.65
|
| Rate for Payer: Anthem Medicaid |
$944.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,141.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$2,278.35
|
| Rate for Payer: First Health Commercial |
$2,607.75
|
| Rate for Payer: Humana Commercial |
$2,333.25
|
| Rate for Payer: Humana KY Medicaid |
$944.01
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$953.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,250.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,025.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$962.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,415.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,388.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,894.05
|
| Rate for Payer: PHCS Commercial |
$2,635.20
|
| Rate for Payer: United Healthcare All Payer |
$2,415.60
|
|
|
SCLEROTX FLUID COLLECTION (T
|
Facility
|
IP
|
$2,745.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
761T2943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.50 |
| Max. Negotiated Rate |
$2,635.20 |
| Rate for Payer: Aetna Commercial |
$2,113.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,141.10
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$2,278.35
|
| Rate for Payer: First Health Commercial |
$2,607.75
|
| Rate for Payer: Humana Commercial |
$2,333.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,250.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,025.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$823.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,415.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,388.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,894.05
|
| Rate for Payer: PHCS Commercial |
$2,635.20
|
| Rate for Payer: United Healthcare All Payer |
$2,415.60
|
|
|
SCOPOLAMINE 2.5MG TABLET
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
NDC 76385010001
|
| Hospital Charge Code |
25001374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Anthem Medicaid |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.29
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.76
|
| Rate for Payer: First Health Commercial |
$8.88
|
| Rate for Payer: Humana Commercial |
$7.95
|
| Rate for Payer: Humana KY Medicaid |
$3.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.23
|
| Rate for Payer: Ohio Health Group HMO |
$7.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.45
|
| Rate for Payer: PHCS Commercial |
$8.98
|
| Rate for Payer: United Healthcare All Payer |
$8.23
|
|
|
SCOPOLAMINE 2.5MG TABLET
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
NDC 76385010001
|
| Hospital Charge Code |
25001374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.29
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.76
|
| Rate for Payer: First Health Commercial |
$8.88
|
| Rate for Payer: Humana Commercial |
$7.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.23
|
| Rate for Payer: Ohio Health Group HMO |
$7.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.45
|
| Rate for Payer: PHCS Commercial |
$8.98
|
| Rate for Payer: United Healthcare All Payer |
$8.23
|
|
|
SCOREFLEX NC SCORING 2.5 X 20
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
SCOREFLEX NC SCORING 2.5 X 20
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
SCOREFLEX NC SCORING 4 X 20
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
SCOREFLEX NC SCORING 4 X 20
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
SCORPIO CR FEM COMP #7 R LFIT
|
Facility
|
OP
|
$17,068.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,120.64 |
| Max. Negotiated Rate |
$16,386.05 |
| Rate for Payer: Aetna Commercial |
$13,142.98
|
| Rate for Payer: Anthem Medicaid |
$5,869.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,313.66
|
| Rate for Payer: Cash Price |
$8,534.40
|
| Rate for Payer: Cigna Commercial |
$14,167.10
|
| Rate for Payer: First Health Commercial |
$16,215.36
|
| Rate for Payer: Humana Commercial |
$14,508.48
|
| Rate for Payer: Humana KY Medicaid |
$5,869.96
|
| Rate for Payer: Kentucky WC Medicaid |
$5,929.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,996.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,596.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,120.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,987.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,020.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,801.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,655.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,849.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,777.47
|
| Rate for Payer: PHCS Commercial |
$16,386.05
|
| Rate for Payer: United Healthcare All Payer |
$15,020.54
|
|
|
SCORPIO CR FEM COMP #7 R LFIT
|
Facility
|
IP
|
$17,068.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,120.64 |
| Max. Negotiated Rate |
$16,386.05 |
| Rate for Payer: Aetna Commercial |
$13,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,313.66
|
| Rate for Payer: Cash Price |
$8,534.40
|
| Rate for Payer: Cigna Commercial |
$14,167.10
|
| Rate for Payer: First Health Commercial |
$16,215.36
|
| Rate for Payer: Humana Commercial |
$14,508.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,996.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,596.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,120.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,020.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,801.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,655.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,849.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,777.47
|
| Rate for Payer: PHCS Commercial |
$16,386.05
|
| Rate for Payer: United Healthcare All Payer |
$15,020.54
|
|
|
SCORPIO CR FEMORAL COMP #13 L
|
Facility
|
IP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
SCORPIO CR FEMORAL COMP #13 L
|
Facility
|
OP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem Medicaid |
$4,560.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Humana KY Medicaid |
$4,560.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,607.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,652.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
SCORPIO CR FEMORAL COMP #7 L
|
Facility
|
OP
|
$13,088.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.69 |
| Max. Negotiated Rate |
$12,565.42 |
| Rate for Payer: Aetna Commercial |
$10,078.51
|
| Rate for Payer: Anthem Medicaid |
$4,501.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,209.40
|
| Rate for Payer: Cash Price |
$6,544.49
|
| Rate for Payer: Cigna Commercial |
$10,863.85
|
| Rate for Payer: First Health Commercial |
$12,434.53
|
| Rate for Payer: Humana Commercial |
$11,125.63
|
| Rate for Payer: Humana KY Medicaid |
$4,501.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,547.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,732.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,659.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,926.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,591.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,518.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,816.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,471.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,387.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,031.40
|
| Rate for Payer: PHCS Commercial |
$12,565.42
|
| Rate for Payer: United Healthcare All Payer |
$11,518.30
|
|
|
SCORPIO CR FEMORAL COMP #7 L
|
Facility
|
IP
|
$13,088.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.69 |
| Max. Negotiated Rate |
$12,565.42 |
| Rate for Payer: Aetna Commercial |
$10,078.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,209.40
|
| Rate for Payer: Cash Price |
$6,544.49
|
| Rate for Payer: Cigna Commercial |
$10,863.85
|
| Rate for Payer: First Health Commercial |
$12,434.53
|
| Rate for Payer: Humana Commercial |
$11,125.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,732.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,659.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,926.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,518.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,816.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,471.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,387.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,031.40
|
| Rate for Payer: PHCS Commercial |
$12,565.42
|
| Rate for Payer: United Healthcare All Payer |
$11,518.30
|
|
|
SCORPIO CR FEMORAL COMP #7 R
|
Facility
|
IP
|
$13,088.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.69 |
| Max. Negotiated Rate |
$12,565.42 |
| Rate for Payer: Aetna Commercial |
$10,078.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,209.40
|
| Rate for Payer: Cash Price |
$6,544.49
|
| Rate for Payer: Cigna Commercial |
$10,863.85
|
| Rate for Payer: First Health Commercial |
$12,434.53
|
| Rate for Payer: Humana Commercial |
$11,125.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,732.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,659.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,926.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,518.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,816.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,471.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,387.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,031.40
|
| Rate for Payer: PHCS Commercial |
$12,565.42
|
| Rate for Payer: United Healthcare All Payer |
$11,518.30
|
|
|
SCORPIO CR FEMORAL COMP #7 R
|
Facility
|
OP
|
$13,088.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.69 |
| Max. Negotiated Rate |
$12,565.42 |
| Rate for Payer: Aetna Commercial |
$10,078.51
|
| Rate for Payer: Anthem Medicaid |
$4,501.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,209.40
|
| Rate for Payer: Cash Price |
$6,544.49
|
| Rate for Payer: Cigna Commercial |
$10,863.85
|
| Rate for Payer: First Health Commercial |
$12,434.53
|
| Rate for Payer: Humana Commercial |
$11,125.63
|
| Rate for Payer: Humana KY Medicaid |
$4,501.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,547.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,732.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,659.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,926.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,591.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,518.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,816.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,471.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,387.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,031.40
|
| Rate for Payer: PHCS Commercial |
$12,565.42
|
| Rate for Payer: United Healthcare All Payer |
$11,518.30
|
|
