|
SCORPIO CR FEMORAL COMP #9 L
|
Facility
|
OP
|
$12,630.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,789.29 |
| Max. Negotiated Rate |
$12,125.72 |
| Rate for Payer: Aetna Commercial |
$9,725.84
|
| Rate for Payer: Anthem Medicaid |
$4,343.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,852.15
|
| Rate for Payer: Cash Price |
$6,315.48
|
| Rate for Payer: Cigna Commercial |
$10,483.70
|
| Rate for Payer: First Health Commercial |
$11,999.41
|
| Rate for Payer: Humana Commercial |
$10,736.32
|
| Rate for Payer: Humana KY Medicaid |
$4,343.79
|
| Rate for Payer: Kentucky WC Medicaid |
$4,388.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,357.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,321.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,789.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,430.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,115.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,473.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,104.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,988.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,715.36
|
| Rate for Payer: PHCS Commercial |
$12,125.72
|
| Rate for Payer: United Healthcare All Payer |
$11,115.24
|
|
|
SCORPIO CR FEMORAL COMP #9 L
|
Facility
|
IP
|
$12,630.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,789.29 |
| Max. Negotiated Rate |
$12,125.72 |
| Rate for Payer: Aetna Commercial |
$9,725.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,852.15
|
| Rate for Payer: Cash Price |
$6,315.48
|
| Rate for Payer: Cigna Commercial |
$10,483.70
|
| Rate for Payer: First Health Commercial |
$11,999.41
|
| Rate for Payer: Humana Commercial |
$10,736.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,357.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,321.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,789.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,115.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,473.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,104.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,988.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,715.36
|
| Rate for Payer: PHCS Commercial |
$12,125.72
|
| Rate for Payer: United Healthcare All Payer |
$11,115.24
|
|
|
SCORPIO CR INSERT #11/13 15MM
|
Facility
|
IP
|
$5,231.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.30 |
| Max. Negotiated Rate |
$5,021.76 |
| Rate for Payer: Aetna Commercial |
$4,027.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,080.18
|
| Rate for Payer: Cash Price |
$2,615.50
|
| Rate for Payer: Cigna Commercial |
$4,341.73
|
| Rate for Payer: First Health Commercial |
$4,969.45
|
| Rate for Payer: Humana Commercial |
$4,446.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,289.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,860.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,569.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,603.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,923.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,550.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,609.39
|
| Rate for Payer: PHCS Commercial |
$5,021.76
|
| Rate for Payer: United Healthcare All Payer |
$4,603.28
|
|
|
SCORPIO CR INSERT #11/13 15MM
|
Facility
|
OP
|
$5,231.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.30 |
| Max. Negotiated Rate |
$5,021.76 |
| Rate for Payer: Aetna Commercial |
$4,027.87
|
| Rate for Payer: Anthem Medicaid |
$1,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,080.18
|
| Rate for Payer: Cash Price |
$2,615.50
|
| Rate for Payer: Cigna Commercial |
$4,341.73
|
| Rate for Payer: First Health Commercial |
$4,969.45
|
| Rate for Payer: Humana Commercial |
$4,446.35
|
| Rate for Payer: Humana KY Medicaid |
$1,798.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,817.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,289.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,860.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,569.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,835.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,603.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,923.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,550.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,609.39
|
| Rate for Payer: PHCS Commercial |
$5,021.76
|
| Rate for Payer: United Healthcare All Payer |
$4,603.28
|
|
|
SCORPIO FEMORAL COMP #9 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 FEMORAL COMP #9 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
|
|
|
SCORPIO PATELLA DOME #3/8MM
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem Medicaid |
$1,535.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Humana KY Medicaid |
$1,535.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,566.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PATELLA DOME #3/8MM
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PATELLA DOME #5/8MM
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PATELLA DOME #5/8MM
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem Medicaid |
$1,535.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Humana KY Medicaid |
$1,535.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,566.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PATELLA DOME #7/8MM
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem Medicaid |
$1,535.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Humana KY Medicaid |
$1,535.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,566.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PATELLA DOME #7/8MM
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PAT MED DOME SZ 11 10M
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem Medicaid |
$1,535.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Humana KY Medicaid |
$1,535.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,566.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PAT MED DOME SZ 11 10M
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.80 |
| Max. Negotiated Rate |
$4,287.36 |
| Rate for Payer: Aetna Commercial |
$3,438.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,483.48
|
| Rate for Payer: Cash Price |
$2,233.00
|
| Rate for Payer: Cigna Commercial |
$3,706.78
|
| Rate for Payer: First Health Commercial |
$4,242.70
|
| Rate for Payer: Humana Commercial |
$3,796.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,295.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,885.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.54
|
| Rate for Payer: PHCS Commercial |
$4,287.36
|
| Rate for Payer: United Healthcare All Payer |
$3,930.08
|
|
|
SCORPIO PAT MED DOME SZ 5 10MM
|
Facility
|
OP
|
$4,529.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.70 |
| Max. Negotiated Rate |
$4,347.84 |
| Rate for Payer: Aetna Commercial |
$3,487.33
|
| Rate for Payer: Anthem Medicaid |
$1,557.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.62
|
| Rate for Payer: Cash Price |
$2,264.50
|
| Rate for Payer: Cigna Commercial |
$3,759.07
|
| Rate for Payer: First Health Commercial |
$4,302.55
|
| Rate for Payer: Humana Commercial |
$3,849.65
|
| Rate for Payer: Humana KY Medicaid |
$1,557.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,573.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,623.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,940.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.01
|
| Rate for Payer: PHCS Commercial |
$4,347.84
|
| Rate for Payer: United Healthcare All Payer |
$3,985.52
|
|
|
SCORPIO PAT MED DOME SZ 5 10MM
|
Facility
|
IP
|
$4,529.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.70 |
| Max. Negotiated Rate |
$4,347.84 |
| Rate for Payer: Aetna Commercial |
$3,487.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.62
|
| Rate for Payer: Cash Price |
$2,264.50
|
| Rate for Payer: Cigna Commercial |
$3,759.07
|
| Rate for Payer: First Health Commercial |
$4,302.55
|
| Rate for Payer: Humana Commercial |
$3,849.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,623.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,940.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.01
|
| Rate for Payer: PHCS Commercial |
$4,347.84
|
| Rate for Payer: United Healthcare All Payer |
$3,985.52
|
|
|
SCORPIO PAT MED DOME SZ 7 10MM
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
SCORPIO PAT MED DOME SZ 7 10MM
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
SCORPIO PAT MED DOME SZ 9 10MM
|
Facility
|
IP
|
$4,529.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.70 |
| Max. Negotiated Rate |
$4,347.84 |
| Rate for Payer: Aetna Commercial |
$3,487.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.62
|
| Rate for Payer: Cash Price |
$2,264.50
|
| Rate for Payer: Cigna Commercial |
$3,759.07
|
| Rate for Payer: First Health Commercial |
$4,302.55
|
| Rate for Payer: Humana Commercial |
$3,849.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,623.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,940.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.01
|
| Rate for Payer: PHCS Commercial |
$4,347.84
|
| Rate for Payer: United Healthcare All Payer |
$3,985.52
|
|
|
SCORPIO PAT MED DOME SZ 9 10MM
|
Facility
|
OP
|
$4,529.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.70 |
| Max. Negotiated Rate |
$4,347.84 |
| Rate for Payer: Aetna Commercial |
$3,487.33
|
| Rate for Payer: Anthem Medicaid |
$1,557.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.62
|
| Rate for Payer: Cash Price |
$2,264.50
|
| Rate for Payer: Cigna Commercial |
$3,759.07
|
| Rate for Payer: First Health Commercial |
$4,302.55
|
| Rate for Payer: Humana Commercial |
$3,849.65
|
| Rate for Payer: Humana KY Medicaid |
$1,557.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,573.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,623.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,940.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.01
|
| Rate for Payer: PHCS Commercial |
$4,347.84
|
| Rate for Payer: United Healthcare All Payer |
$3,985.52
|
|
|
SCORPIO P/S FEMORAL SZ 11 LT
|
Facility
|
OP
|
$13,479.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,043.84 |
| Max. Negotiated Rate |
$12,940.28 |
| Rate for Payer: Aetna Commercial |
$10,379.18
|
| Rate for Payer: Anthem Medicaid |
$4,635.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,513.98
|
| Rate for Payer: Cash Price |
$6,739.73
|
| Rate for Payer: Cigna Commercial |
$11,187.95
|
| Rate for Payer: First Health Commercial |
$12,805.49
|
| Rate for Payer: Humana Commercial |
$11,457.54
|
| Rate for Payer: Humana KY Medicaid |
$4,635.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,682.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,053.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,947.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,043.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,728.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,861.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,109.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,783.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,727.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,300.83
|
| Rate for Payer: PHCS Commercial |
$12,940.28
|
| Rate for Payer: United Healthcare All Payer |
$11,861.92
|
|
|
SCORPIO P/S FEMORAL SZ 11 LT
|
Facility
|
IP
|
$13,479.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,043.84 |
| Max. Negotiated Rate |
$12,940.28 |
| Rate for Payer: Aetna Commercial |
$10,379.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,513.98
|
| Rate for Payer: Cash Price |
$6,739.73
|
| Rate for Payer: Cigna Commercial |
$11,187.95
|
| Rate for Payer: First Health Commercial |
$12,805.49
|
| Rate for Payer: Humana Commercial |
$11,457.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,053.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,947.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,043.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,861.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,109.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,783.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,727.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,300.83
|
| Rate for Payer: PHCS Commercial |
$12,940.28
|
| Rate for Payer: United Healthcare All Payer |
$11,861.92
|
|
|
SCORPIO P/S FEMORAL SZ 11 RT
|
Facility
|
IP
|
$13,003.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,901.15 |
| Max. Negotiated Rate |
$12,483.68 |
| Rate for Payer: Aetna Commercial |
$10,012.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,142.99
|
| Rate for Payer: Cash Price |
$6,501.92
|
| Rate for Payer: Cigna Commercial |
$10,793.18
|
| Rate for Payer: First Health Commercial |
$12,353.64
|
| Rate for Payer: Humana Commercial |
$11,053.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,663.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,596.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,901.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,443.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,752.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,313.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,972.64
|
| Rate for Payer: PHCS Commercial |
$12,483.68
|
| Rate for Payer: United Healthcare All Payer |
$11,443.37
|
|
|
SCORPIO P/S FEMORAL SZ 11 RT
|
Facility
|
OP
|
$13,003.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,901.15 |
| Max. Negotiated Rate |
$12,483.68 |
| Rate for Payer: Aetna Commercial |
$10,012.95
|
| Rate for Payer: Anthem Medicaid |
$4,472.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,142.99
|
| Rate for Payer: Cash Price |
$6,501.92
|
| Rate for Payer: Cigna Commercial |
$10,793.18
|
| Rate for Payer: First Health Commercial |
$12,353.64
|
| Rate for Payer: Humana Commercial |
$11,053.26
|
| Rate for Payer: Humana KY Medicaid |
$4,472.02
|
| Rate for Payer: Kentucky WC Medicaid |
$4,517.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,663.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,596.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,901.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,561.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,443.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,752.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,313.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,972.64
|
| Rate for Payer: PHCS Commercial |
$12,483.68
|
| Rate for Payer: United Healthcare All Payer |
$11,443.37
|
|
|
SCORPIO P/S FEMORAL SZ 13 LT
|
Facility
|
OP
|
$11,162.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,348.89 |
| Max. Negotiated Rate |
$10,716.44 |
| Rate for Payer: Aetna Commercial |
$8,595.48
|
| Rate for Payer: Anthem Medicaid |
$3,838.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,707.11
|
| Rate for Payer: Cash Price |
$5,581.48
|
| Rate for Payer: Cigna Commercial |
$9,265.26
|
| Rate for Payer: First Health Commercial |
$10,604.81
|
| Rate for Payer: Humana Commercial |
$9,488.52
|
| Rate for Payer: Humana KY Medicaid |
$3,838.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,878.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,153.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,238.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,348.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,915.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,823.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,372.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,930.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,711.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,702.44
|
| Rate for Payer: PHCS Commercial |
$10,716.44
|
| Rate for Payer: United Healthcare All Payer |
$9,823.40
|
|
