|
SCORPIO TIBIAL BASE SZ 5
|
Facility
|
OP
|
$8,863.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.01 |
| Max. Negotiated Rate |
$8,508.83 |
| Rate for Payer: Aetna Commercial |
$6,824.79
|
| Rate for Payer: Anthem Medicaid |
$3,048.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,913.42
|
| Rate for Payer: Cash Price |
$4,431.68
|
| Rate for Payer: Cigna Commercial |
$7,356.59
|
| Rate for Payer: First Health Commercial |
$8,420.19
|
| Rate for Payer: Humana Commercial |
$7,533.86
|
| Rate for Payer: Humana KY Medicaid |
$3,048.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,267.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,541.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,799.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,647.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,090.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,711.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,115.72
|
| Rate for Payer: PHCS Commercial |
$8,508.83
|
| Rate for Payer: United Healthcare All Payer |
$7,799.76
|
|
|
SCORPIO TIBIAL BASE SZ 5
|
Facility
|
IP
|
$8,863.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.01 |
| Max. Negotiated Rate |
$8,508.83 |
| Rate for Payer: Aetna Commercial |
$6,824.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,913.42
|
| Rate for Payer: Cash Price |
$4,431.68
|
| Rate for Payer: Cigna Commercial |
$7,356.59
|
| Rate for Payer: First Health Commercial |
$8,420.19
|
| Rate for Payer: Humana Commercial |
$7,533.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,267.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,541.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,799.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,647.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,090.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,711.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,115.72
|
| Rate for Payer: PHCS Commercial |
$8,508.83
|
| Rate for Payer: United Healthcare All Payer |
$7,799.76
|
|
|
SCORPIO TIBIAL BASE SZ 7
|
Facility
|
IP
|
$8,863.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.01 |
| Max. Negotiated Rate |
$8,508.83 |
| Rate for Payer: Aetna Commercial |
$6,824.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,913.42
|
| Rate for Payer: Cash Price |
$4,431.68
|
| Rate for Payer: Cigna Commercial |
$7,356.59
|
| Rate for Payer: First Health Commercial |
$8,420.19
|
| Rate for Payer: Humana Commercial |
$7,533.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,267.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,541.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,799.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,647.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,090.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,711.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,115.72
|
| Rate for Payer: PHCS Commercial |
$8,508.83
|
| Rate for Payer: United Healthcare All Payer |
$7,799.76
|
|
|
SCORPIO TIBIAL BASE SZ 7
|
Facility
|
OP
|
$8,863.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.01 |
| Max. Negotiated Rate |
$8,508.83 |
| Rate for Payer: Aetna Commercial |
$6,824.79
|
| Rate for Payer: Anthem Medicaid |
$3,048.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,913.42
|
| Rate for Payer: Cash Price |
$4,431.68
|
| Rate for Payer: Cigna Commercial |
$7,356.59
|
| Rate for Payer: First Health Commercial |
$8,420.19
|
| Rate for Payer: Humana Commercial |
$7,533.86
|
| Rate for Payer: Humana KY Medicaid |
$3,048.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,267.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,541.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,799.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,647.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,090.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,711.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,115.72
|
| Rate for Payer: PHCS Commercial |
$8,508.83
|
| Rate for Payer: United Healthcare All Payer |
$7,799.76
|
|
|
SCORPIO TIBIAL BASE SZ 9
|
Facility
|
OP
|
$8,583.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.91 |
| Max. Negotiated Rate |
$8,239.72 |
| Rate for Payer: Aetna Commercial |
$6,608.94
|
| Rate for Payer: Anthem Medicaid |
$2,951.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,694.77
|
| Rate for Payer: Cash Price |
$4,291.52
|
| Rate for Payer: Cigna Commercial |
$7,123.92
|
| Rate for Payer: First Health Commercial |
$8,153.89
|
| Rate for Payer: Humana Commercial |
$7,295.58
|
| Rate for Payer: Humana KY Medicaid |
$2,951.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,981.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,038.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,334.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,010.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,553.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,866.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,467.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,922.30
|
| Rate for Payer: PHCS Commercial |
$8,239.72
|
| Rate for Payer: United Healthcare All Payer |
$7,553.08
|
|
|
SCORPIO TIBIAL BASE SZ 9
|
Facility
|
IP
|
$8,583.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.91 |
| Max. Negotiated Rate |
$8,239.72 |
| Rate for Payer: Aetna Commercial |
$6,608.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,694.77
|
| Rate for Payer: Cash Price |
$4,291.52
|
| Rate for Payer: Cigna Commercial |
$7,123.92
|
| Rate for Payer: First Health Commercial |
$8,153.89
|
| Rate for Payer: Humana Commercial |
$7,295.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,038.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,334.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,553.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,866.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,467.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,922.30
|
| Rate for Payer: PHCS Commercial |
$8,239.72
|
| Rate for Payer: United Healthcare All Payer |
$7,553.08
|
|
|
SCORPIO TIBIAL INST CR 15MM #7
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIBIAL INST CR 15MM #7
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 7 15MM
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 7 15MM
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 7 8MM
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 7 8MM
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 8 11/13
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TIB INSERT SZ 8 11/13
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
SCORPIO TS FULL TIBIAL WDG #11
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDG #11
|
Facility
|
OP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem Medicaid |
$2,550.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Humana KY Medicaid |
$2,550.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDG #13
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDG #13
|
Facility
|
OP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem Medicaid |
$2,550.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Humana KY Medicaid |
$2,550.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDGE #3
|
Facility
|
IP
|
$7,634.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,290.21 |
| Max. Negotiated Rate |
$7,328.68 |
| Rate for Payer: Aetna Commercial |
$5,878.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.55
|
| Rate for Payer: Cash Price |
$3,817.02
|
| Rate for Payer: Cigna Commercial |
$6,336.25
|
| Rate for Payer: First Health Commercial |
$7,252.34
|
| Rate for Payer: Humana Commercial |
$6,488.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,107.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,641.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,267.49
|
| Rate for Payer: PHCS Commercial |
$7,328.68
|
| Rate for Payer: United Healthcare All Payer |
$6,717.96
|
|
|
SCORPIO TS FULL TIBIAL WDGE #3
|
Facility
|
OP
|
$7,634.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,290.21 |
| Max. Negotiated Rate |
$7,328.68 |
| Rate for Payer: Aetna Commercial |
$5,878.21
|
| Rate for Payer: Anthem Medicaid |
$2,625.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.55
|
| Rate for Payer: Cash Price |
$3,817.02
|
| Rate for Payer: Cigna Commercial |
$6,336.25
|
| Rate for Payer: First Health Commercial |
$7,252.34
|
| Rate for Payer: Humana Commercial |
$6,488.93
|
| Rate for Payer: Humana KY Medicaid |
$2,625.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,652.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,678.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,107.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,641.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,267.49
|
| Rate for Payer: PHCS Commercial |
$7,328.68
|
| Rate for Payer: United Healthcare All Payer |
$6,717.96
|
|
|
SCORPIO TS FULL TIBIAL WDGE #5
|
Facility
|
OP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem Medicaid |
$2,550.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Humana KY Medicaid |
$2,550.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDGE #5
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDGE #7
|
Facility
|
OP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem Medicaid |
$2,550.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Humana KY Medicaid |
$2,550.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDGE #7
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
SCORPIO TS FULL TIBIAL WDGE #9
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
