|
LIGATION VARICO 1 CLUSTR 1 LEG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
761P1583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.99 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$402.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.99
|
| Rate for Payer: Anthem Medicaid |
$135.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$384.40
|
| Rate for Payer: Healthspan PPO |
$421.63
|
| Rate for Payer: Humana Medicaid |
$135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.82
|
| Rate for Payer: Molina Healthcare Passport |
$135.12
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$137.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.47
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$389.66
|
| Rate for Payer: Anthem Medicaid |
$218.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$378.49
|
| Rate for Payer: Healthspan PPO |
$311.56
|
| Rate for Payer: Humana Medicaid |
$218.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$332.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.03
|
| Rate for Payer: Molina Healthcare Passport |
$218.66
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.85
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LIG DIV SAPHENOFEM JUNC(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
761P1578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$389.66
|
| Rate for Payer: Anthem Medicaid |
$218.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$378.49
|
| Rate for Payer: Healthspan PPO |
$311.56
|
| Rate for Payer: Humana Medicaid |
$218.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$332.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.03
|
| Rate for Payer: Molina Healthcare Passport |
$218.66
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.85
|
|
|
LILETTA 24HR IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
25002482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LILETTA 24HR IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LILETTA 24HR IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LILETTA 24HR IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
636T0070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LILETTA 24HR IUD
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,155.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,222.39
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
|
|
LILETTA 24HR IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
636T0070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LILETTA 24HR IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
25002482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
LIMB EXTENSION 16-16-55L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LIMB EXTENSION 16-16-55L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LIMB EXTENSION 16-16-88L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LIMB EXTENSION 16-16-88L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LIMB EXT INTUITRAK 16-16-55FL
|
Facility
|
IP
|
$11,859.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.70 |
| Max. Negotiated Rate |
$11,384.88 |
| Rate for Payer: Aetna Commercial |
$9,131.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,250.22
|
| Rate for Payer: Cash Price |
$5,929.62
|
| Rate for Payer: Cigna Commercial |
$9,843.18
|
| Rate for Payer: First Health Commercial |
$11,266.29
|
| Rate for Payer: Humana Commercial |
$10,080.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,724.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,557.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,436.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,894.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,371.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,676.37
|
| Rate for Payer: PHCS Commercial |
$11,384.88
|
| Rate for Payer: United Healthcare All Payer |
$10,436.14
|
|
|
LIMB EXT INTUITRAK 16-16-55FL
|
Facility
|
OP
|
$11,859.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.70 |
| Max. Negotiated Rate |
$11,384.88 |
| Rate for Payer: Aetna Commercial |
$9,131.62
|
| Rate for Payer: Anthem Medicaid |
$4,078.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,250.22
|
| Rate for Payer: Cash Price |
$5,929.62
|
| Rate for Payer: Cigna Commercial |
$9,843.18
|
| Rate for Payer: First Health Commercial |
$11,266.29
|
| Rate for Payer: Humana Commercial |
$10,080.36
|
| Rate for Payer: Humana KY Medicaid |
$4,078.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,119.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,724.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,557.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,160.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,436.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,894.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,371.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,676.37
|
| Rate for Payer: PHCS Commercial |
$11,384.88
|
| Rate for Payer: United Healthcare All Payer |
$10,436.14
|
|
|
LIMB EXT INTUITRAK 20-20-55FL
|
Facility
|
IP
|
$11,859.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.70 |
| Max. Negotiated Rate |
$11,384.88 |
| Rate for Payer: Aetna Commercial |
$9,131.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,250.22
|
| Rate for Payer: Cash Price |
$5,929.62
|
| Rate for Payer: Cigna Commercial |
$9,843.18
|
| Rate for Payer: First Health Commercial |
$11,266.29
|
| Rate for Payer: Humana Commercial |
$10,080.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,724.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,557.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,436.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,894.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,371.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,676.37
|
| Rate for Payer: PHCS Commercial |
$11,384.88
|
| Rate for Payer: United Healthcare All Payer |
$10,436.14
|
|
|
LIMB EXT INTUITRAK 20-20-55FL
|
Facility
|
OP
|
$11,859.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.70 |
| Max. Negotiated Rate |
$11,384.88 |
| Rate for Payer: Aetna Commercial |
$9,131.62
|
| Rate for Payer: Anthem Medicaid |
$4,078.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,250.22
|
| Rate for Payer: Cash Price |
$5,929.62
|
| Rate for Payer: Cigna Commercial |
$9,843.18
|
| Rate for Payer: First Health Commercial |
$11,266.29
|
| Rate for Payer: Humana Commercial |
$10,080.36
|
| Rate for Payer: Humana KY Medicaid |
$4,078.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,119.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,724.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,557.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,160.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,436.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,894.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,371.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,676.37
|
| Rate for Payer: PHCS Commercial |
$11,384.88
|
| Rate for Payer: United Healthcare All Payer |
$10,436.14
|
|
|
LIMB EXT INTUITRAK 20-25-65F
|
Facility
|
IP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.95 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,736.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,242.12
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
LIMB EXT INTUITRAK 20-25-65F
|
Facility
|
OP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.95 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem Medicaid |
$4,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Humana KY Medicaid |
$4,706.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,753.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,736.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,242.12
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
LIMB EXT INTUTRAK 20-25-55S SS
|
Facility
|
OP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.95 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem Medicaid |
$4,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Humana KY Medicaid |
$4,706.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,753.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,736.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,242.12
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
LIMB EXT INTUTRAK 20-25-55S SS
|
Facility
|
IP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.95 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,736.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,242.12
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
LIMB EXT INTUTRK 16-16-55L STR
|
Facility
|
OP
|
$11,859.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.70 |
| Max. Negotiated Rate |
$11,384.88 |
| Rate for Payer: Aetna Commercial |
$9,131.62
|
| Rate for Payer: Anthem Medicaid |
$4,078.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,250.22
|
| Rate for Payer: Cash Price |
$5,929.62
|
| Rate for Payer: Cigna Commercial |
$9,843.18
|
| Rate for Payer: First Health Commercial |
$11,266.29
|
| Rate for Payer: Humana Commercial |
$10,080.36
|
| Rate for Payer: Humana KY Medicaid |
$4,078.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,119.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,724.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,557.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,160.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,436.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,894.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,371.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,541.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,676.37
|
| Rate for Payer: PHCS Commercial |
$11,384.88
|
| Rate for Payer: United Healthcare All Payer |
$10,436.14
|
|
