|
SCORPIO TS FULL TIBIAL WDGE #9
|
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
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
IP
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.32 |
| Max. Negotiated Rate |
$2,324.24 |
| Rate for Payer: Aetna Commercial |
$1,864.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,888.44
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$2,009.50
|
| Rate for Payer: First Health Commercial |
$2,300.03
|
| Rate for Payer: Humana Commercial |
$2,057.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,985.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,786.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,130.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,936.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,106.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,670.55
|
| Rate for Payer: PHCS Commercial |
$2,324.24
|
| Rate for Payer: United Healthcare All Payer |
$2,130.55
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.70 |
| Max. Negotiated Rate |
$1,285.44 |
| Rate for Payer: Aetna Commercial |
$1,031.03
|
| Rate for Payer: Anthem Medicaid |
$460.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,044.42
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cigna Commercial |
$1,111.37
|
| Rate for Payer: First Health Commercial |
$1,272.05
|
| Rate for Payer: Humana Commercial |
$1,138.15
|
| Rate for Payer: Humana KY Medicaid |
$460.48
|
| Rate for Payer: Kentucky WC Medicaid |
$465.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,097.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$469.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,178.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,004.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,071.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.91
|
| Rate for Payer: PHCS Commercial |
$1,285.44
|
| Rate for Payer: United Healthcare All Payer |
$1,178.32
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Professional
|
Both
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$1,452.65 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Ambetter Exchange |
$49.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.29
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$83.10
|
| Rate for Payer: Healthspan PPO |
$299.12
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$1,452.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.23
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.41
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.70 |
| Max. Negotiated Rate |
$1,285.44 |
| Rate for Payer: Aetna Commercial |
$1,031.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,044.42
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cigna Commercial |
$1,111.37
|
| Rate for Payer: First Health Commercial |
$1,272.05
|
| Rate for Payer: Humana Commercial |
$1,138.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,097.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,178.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,004.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,071.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.91
|
| Rate for Payer: PHCS Commercial |
$1,285.44
|
| Rate for Payer: United Healthcare All Payer |
$1,178.32
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR
|
Facility
|
OP
|
$2,421.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
76101442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.32 |
| Max. Negotiated Rate |
$2,324.24 |
| Rate for Payer: Aetna Commercial |
$1,864.23
|
| Rate for Payer: Anthem Medicaid |
$832.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,888.44
|
| Rate for Payer: Cash Price |
$1,210.54
|
| Rate for Payer: Cigna Commercial |
$2,009.50
|
| Rate for Payer: First Health Commercial |
$2,300.03
|
| Rate for Payer: Humana Commercial |
$2,057.92
|
| Rate for Payer: Humana KY Medicaid |
$832.61
|
| Rate for Payer: Kentucky WC Medicaid |
$841.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,985.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,786.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,130.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,936.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,106.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,670.55
|
| Rate for Payer: PHCS Commercial |
$2,324.24
|
| Rate for Payer: United Healthcare All Payer |
$2,130.55
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(P
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761P1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$299.12 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Ambetter Exchange |
$49.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.29
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$83.10
|
| Rate for Payer: Healthspan PPO |
$299.12
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$270.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.23
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.41
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(T
|
Facility
|
IP
|
$1,970.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761T1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.02 |
| Max. Negotiated Rate |
$1,891.28 |
| Rate for Payer: Aetna Commercial |
$1,516.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.66
|
| Rate for Payer: Cash Price |
$985.04
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: First Health Commercial |
$1,871.58
|
| Rate for Payer: Humana Commercial |
$1,674.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.36
|
| Rate for Payer: PHCS Commercial |
$1,891.28
|
| Rate for Payer: United Healthcare All Payer |
$1,733.67
|
|
|
SCP ADDL 2-3RD &> BRACH/THOR(T
|
Facility
|
OP
|
$1,970.08
|
|
|
Service Code
|
HCPCS 36218
|
| Hospital Charge Code |
761T1442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.02 |
| Max. Negotiated Rate |
$1,891.28 |
| Rate for Payer: Aetna Commercial |
$1,516.96
|
| Rate for Payer: Anthem Medicaid |
$677.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.66
|
| Rate for Payer: Cash Price |
$985.04
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: First Health Commercial |
$1,871.58
|
| Rate for Payer: Humana Commercial |
$1,674.57
|
| Rate for Payer: Humana KY Medicaid |
$677.51
|
| Rate for Payer: Kentucky WC Medicaid |
$684.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.36
|
| Rate for Payer: PHCS Commercial |
$1,891.28
|
| Rate for Payer: United Healthcare All Payer |
$1,733.67
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
OP
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,884.90 |
| Max. Negotiated Rate |
$6,031.68 |
| Rate for Payer: Aetna Commercial |
$4,837.91
|
| Rate for Payer: Anthem Medicaid |
$2,160.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,900.74
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$5,214.89
|
| Rate for Payer: First Health Commercial |
$5,968.85
|
| Rate for Payer: Humana Commercial |
$5,340.55
|
| Rate for Payer: Humana KY Medicaid |
$2,160.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,182.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,152.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,636.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,884.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,204.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,529.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,026.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,466.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,335.27
|
| Rate for Payer: PHCS Commercial |
$6,031.68
|
| Rate for Payer: United Healthcare All Payer |
$5,529.04
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$1,322.88 |
| Rate for Payer: Aetna Commercial |
$1,061.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,074.84
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cigna Commercial |
$1,143.74
|
| Rate for Payer: First Health Commercial |
$1,309.10
|
| Rate for Payer: Humana Commercial |
$1,171.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,129.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,016.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,212.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$950.82
|
| Rate for Payer: PHCS Commercial |
$1,322.88
|
| Rate for Payer: United Healthcare All Payer |
$1,212.64
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
IP
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,884.90 |
| Max. Negotiated Rate |
$6,031.68 |
| Rate for Payer: Aetna Commercial |
$4,837.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,900.74
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$5,214.89
|
| Rate for Payer: First Health Commercial |
$5,968.85
|
| Rate for Payer: Humana Commercial |
$5,340.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,152.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,636.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,884.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,529.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,026.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,466.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,335.27
|
| Rate for Payer: PHCS Commercial |
$6,031.68
|
| Rate for Payer: United Healthcare All Payer |
$5,529.04
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Professional
|
Both
|
$6,283.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
76101441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.58 |
| Max. Negotiated Rate |
$3,769.80 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Ambetter Exchange |
$317.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.58
|
| Rate for Payer: Anthem Medicaid |
$297.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$381.38
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cash Price |
$3,141.50
|
| Rate for Payer: Cigna Commercial |
$520.39
|
| Rate for Payer: Healthspan PPO |
$3,147.09
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
| Rate for Payer: Molina Healthcare Passport |
$297.78
|
| Rate for Payer: Multiplan PHCS |
$3,769.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.17
|
| Rate for Payer: UHCCP Medicaid |
$236.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.82
|
|
|
SCP ART INI 3RD> BRACH THOR
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
48100013
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$1,322.88 |
| Rate for Payer: Aetna Commercial |
$1,061.06
|
| Rate for Payer: Anthem Medicaid |
$473.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,074.84
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cigna Commercial |
$1,143.74
|
| Rate for Payer: First Health Commercial |
$1,309.10
|
| Rate for Payer: Humana Commercial |
$1,171.30
|
| Rate for Payer: Humana KY Medicaid |
$473.89
|
| Rate for Payer: Kentucky WC Medicaid |
$478.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,129.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,016.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$483.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,212.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$950.82
|
| Rate for Payer: PHCS Commercial |
$1,322.88
|
| Rate for Payer: United Healthcare All Payer |
$1,212.64
|
|
|
SCP ART INI 3RD> BRACH THOR(P
|
Professional
|
Both
|
$3,141.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761P1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.58 |
| Max. Negotiated Rate |
$3,147.09 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Ambetter Exchange |
$317.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.58
|
| Rate for Payer: Anthem Medicaid |
$297.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$381.38
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$520.39
|
| Rate for Payer: Healthspan PPO |
$3,147.09
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
| Rate for Payer: Molina Healthcare Passport |
$297.78
|
| Rate for Payer: Multiplan PHCS |
$1,884.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.17
|
| Rate for Payer: UHCCP Medicaid |
$236.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.82
|
|
|
SCP ART INI 3RD> BRACH THOR(T
|
Facility
|
OP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761T1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.60 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem Medicaid |
$1,080.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Humana KY Medicaid |
$1,080.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,091.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,733.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,167.98
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
|
SCP ART INI 3RD> BRACH THOR(T
|
Facility
|
IP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761T1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.60 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,733.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,167.98
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
|
SCP COMP KNEE KIT-5CC END DEL
|
Facility
|
IP
|
$20,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.38 |
| Max. Negotiated Rate |
$19,470.00 |
| Rate for Payer: Aetna Commercial |
$15,616.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,819.38
|
| Rate for Payer: Cash Price |
$10,140.62
|
| Rate for Payer: Cigna Commercial |
$16,833.44
|
| Rate for Payer: First Health Commercial |
$19,267.19
|
| Rate for Payer: Humana Commercial |
$17,239.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,630.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,967.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,084.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,847.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,210.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,644.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,994.06
|
| Rate for Payer: PHCS Commercial |
$19,470.00
|
| Rate for Payer: United Healthcare All Payer |
$17,847.50
|
|
|
SCP COMP KNEE KIT-5CC END DEL
|
Facility
|
OP
|
$20,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.38 |
| Max. Negotiated Rate |
$19,470.00 |
| Rate for Payer: Aetna Commercial |
$15,616.56
|
| Rate for Payer: Anthem Medicaid |
$6,974.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,819.38
|
| Rate for Payer: Cash Price |
$10,140.62
|
| Rate for Payer: Cigna Commercial |
$16,833.44
|
| Rate for Payer: First Health Commercial |
$19,267.19
|
| Rate for Payer: Humana Commercial |
$17,239.06
|
| Rate for Payer: Humana KY Medicaid |
$6,974.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7,045.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,630.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,967.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,084.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,114.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,847.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,210.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,644.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,994.06
|
| Rate for Payer: PHCS Commercial |
$19,470.00
|
| Rate for Payer: United Healthcare All Payer |
$17,847.50
|
|
|
SCP COMP KNEE KIT-5CC SIDE DEL
|
Facility
|
OP
|
$20,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.38 |
| Max. Negotiated Rate |
$19,470.00 |
| Rate for Payer: Aetna Commercial |
$15,616.56
|
| Rate for Payer: Anthem Medicaid |
$6,974.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,819.38
|
| Rate for Payer: Cash Price |
$10,140.62
|
| Rate for Payer: Cigna Commercial |
$16,833.44
|
| Rate for Payer: First Health Commercial |
$19,267.19
|
| Rate for Payer: Humana Commercial |
$17,239.06
|
| Rate for Payer: Humana KY Medicaid |
$6,974.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7,045.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,630.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,967.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,084.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,114.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,847.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,210.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,644.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,994.06
|
| Rate for Payer: PHCS Commercial |
$19,470.00
|
| Rate for Payer: United Healthcare All Payer |
$17,847.50
|
|
|
SCP COMP KNEE KIT-5CC SIDE DEL
|
Facility
|
IP
|
$20,281.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.38 |
| Max. Negotiated Rate |
$19,470.00 |
| Rate for Payer: Aetna Commercial |
$15,616.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,819.38
|
| Rate for Payer: Cash Price |
$10,140.62
|
| Rate for Payer: Cigna Commercial |
$16,833.44
|
| Rate for Payer: First Health Commercial |
$19,267.19
|
| Rate for Payer: Humana Commercial |
$17,239.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,630.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,967.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,084.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,847.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,210.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,644.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,994.06
|
| Rate for Payer: PHCS Commercial |
$19,470.00
|
| Rate for Payer: United Healthcare All Payer |
$17,847.50
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
OP
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,515.29 |
| Max. Negotiated Rate |
$4,848.92 |
| Rate for Payer: Aetna Commercial |
$3,889.24
|
| Rate for Payer: Anthem Medicaid |
$1,737.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.75
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$4,192.30
|
| Rate for Payer: First Health Commercial |
$4,798.41
|
| Rate for Payer: Humana Commercial |
$4,293.32
|
| Rate for Payer: Humana KY Medicaid |
$1,737.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.16
|
| Rate for Payer: PHCS Commercial |
$4,848.92
|
| Rate for Payer: United Healthcare All Payer |
$4,444.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
IP
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,515.29 |
| Max. Negotiated Rate |
$4,848.92 |
| Rate for Payer: Aetna Commercial |
$3,889.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.75
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$4,192.30
|
| Rate for Payer: First Health Commercial |
$4,798.41
|
| Rate for Payer: Humana Commercial |
$4,293.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.16
|
| Rate for Payer: PHCS Commercial |
$4,848.92
|
| Rate for Payer: United Healthcare All Payer |
$4,444.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Professional
|
Both
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.81 |
| Max. Negotiated Rate |
$3,030.58 |
| Rate for Payer: Aetna Commercial |
$434.13
|
| Rate for Payer: Ambetter Exchange |
$220.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.81
|
| Rate for Payer: Anthem Medicaid |
$239.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$265.04
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$395.31
|
| Rate for Payer: Healthspan PPO |
$1,954.05
|
| Rate for Payer: Humana Medicaid |
$239.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.37
|
| Rate for Payer: Molina Healthcare Passport |
$239.58
|
| Rate for Payer: Multiplan PHCS |
$3,030.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.13
|
| Rate for Payer: UHCCP Medicaid |
$172.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.87
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$455.10 |
| Max. Negotiated Rate |
$1,456.32 |
| Rate for Payer: Aetna Commercial |
$1,168.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,183.26
|
| Rate for Payer: Cash Price |
$758.50
|
| Rate for Payer: Cigna Commercial |
$1,259.11
|
| Rate for Payer: First Health Commercial |
$1,441.15
|
| Rate for Payer: Humana Commercial |
$1,289.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,243.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,119.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,334.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,137.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,319.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.73
|
| Rate for Payer: PHCS Commercial |
$1,456.32
|
| Rate for Payer: United Healthcare All Payer |
$1,334.96
|
|
