|
LIMB EXT INTUTRK 16-16-55L STR
|
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 INTUTRK 16-16-88L STR
|
Facility
|
OP
|
$12,954.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.05 |
| Max. Negotiated Rate |
$12,436.08 |
| Rate for Payer: Aetna Commercial |
$9,974.77
|
| Rate for Payer: Anthem Medicaid |
$4,454.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,104.32
|
| Rate for Payer: Cash Price |
$6,477.12
|
| Rate for Payer: Cigna Commercial |
$10,752.03
|
| Rate for Payer: First Health Commercial |
$12,306.54
|
| Rate for Payer: Humana Commercial |
$11,011.11
|
| Rate for Payer: Humana KY Medicaid |
$4,454.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,622.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,560.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,399.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,715.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,015.82
|
| Rate for Payer: PHCS Commercial |
$12,436.08
|
| Rate for Payer: United Healthcare All Payer |
$11,399.74
|
|
|
LIMB EXT INTUTRK 16-16-88L STR
|
Facility
|
IP
|
$12,954.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.05 |
| Max. Negotiated Rate |
$12,436.08 |
| Rate for Payer: Aetna Commercial |
$9,974.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,104.32
|
| Rate for Payer: Cash Price |
$6,477.12
|
| Rate for Payer: Cigna Commercial |
$10,752.03
|
| Rate for Payer: First Health Commercial |
$12,306.54
|
| Rate for Payer: Humana Commercial |
$11,011.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,622.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,560.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,399.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,715.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,015.82
|
| Rate for Payer: PHCS Commercial |
$12,436.08
|
| Rate for Payer: United Healthcare All Payer |
$11,399.74
|
|
|
LIMB EXT INTUTRK 20-13-70FL ST
|
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 20-13-70FL ST
|
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 INTUTRK 20-13-88FL LT
|
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 20-13-88FL LT
|
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 INTUTRK 20-20-55L STR
|
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 EXT INTUTRK 20-20-55L STR
|
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 REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$45,367.97
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$30,785.41 |
| Max. Negotiated Rate |
$45,367.97 |
| Rate for Payer: Anthem Medicaid |
$30,785.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32,405.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45,367.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$43,747.68
|
| Rate for Payer: Humana KY Medicaid |
$30,785.41
|
| Rate for Payer: Humana Medicare Advantage |
$32,405.69
|
| Rate for Payer: Kentucky WC Medicaid |
$31,093.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38,886.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,401.11
|
|
|
LIMITED SKULL LESS THAN 4V
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$54.88
|
| Rate for Payer: Anthem Medicaid |
$27.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$54.41
|
| Rate for Payer: Healthspan PPO |
$51.42
|
| Rate for Payer: Humana Medicaid |
$27.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.83
|
| Rate for Payer: Molina Healthcare Passport |
$27.28
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.55
|
|
|
LIMITED SKULL LESS THAN 4V
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
LIMITED SKULL LESS THAN 4V
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
LIMITED SKULL LESS THAN 4V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
320P0017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$54.88 |
| Rate for Payer: Aetna Commercial |
$54.88
|
| Rate for Payer: Anthem Medicaid |
$27.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$54.41
|
| Rate for Payer: Healthspan PPO |
$51.42
|
| Rate for Payer: Humana Medicaid |
$27.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.83
|
| Rate for Payer: Molina Healthcare Passport |
$27.28
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.55
|
|
|
LIMITED SKULL LESS THAN 4V(T
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
320T0017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
LIMITED SKULL LESS THAN 4V(T
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
320T0017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem Medicaid |
$161.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Humana KY Medicaid |
$161.63
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$163.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
LINAR 8 CONTACT LEAD TRIA 50CM
|
Facility
|
OP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem Medicaid |
$2,690.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Humana KY Medicaid |
$2,690.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,717.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINAR 8 CONTACT LEAD TRIA 50CM
|
Facility
|
IP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINAR ST 8 CONTCT LEAD 50CM KT
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
LINAR ST 8 CONTCT LEAD 50CM KT
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
LINAR ST 8 CONTCT LEAD 70CM KT
|
Facility
|
OP
|
$9,632.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.26 |
| Max. Negotiated Rate |
$9,247.49 |
| Rate for Payer: Aetna Commercial |
$7,417.26
|
| Rate for Payer: Anthem Medicaid |
$3,312.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.58
|
| Rate for Payer: Cash Price |
$4,816.40
|
| Rate for Payer: Cigna Commercial |
$7,995.22
|
| Rate for Payer: First Health Commercial |
$9,151.16
|
| Rate for Payer: Humana Commercial |
$8,187.88
|
| Rate for Payer: Humana KY Medicaid |
$3,312.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,346.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,109.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,379.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,926.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,986.17
|
| Rate for Payer: PHCS Commercial |
$9,247.49
|
| Rate for Payer: United Healthcare All Payer |
$8,476.86
|
|
|
LINAR ST 8 CONTCT LEAD 70CM KT
|
Facility
|
IP
|
$9,632.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.26 |
| Max. Negotiated Rate |
$9,247.49 |
| Rate for Payer: Aetna Commercial |
$7,417.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.58
|
| Rate for Payer: Cash Price |
$4,816.40
|
| Rate for Payer: Cigna Commercial |
$7,995.22
|
| Rate for Payer: First Health Commercial |
$9,151.16
|
| Rate for Payer: Humana Commercial |
$8,187.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,109.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,926.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,986.17
|
| Rate for Payer: PHCS Commercial |
$9,247.49
|
| Rate for Payer: United Healthcare All Payer |
$8,476.86
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Professional
|
Both
|
$64.57
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Aetna Commercial |
$14.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.57
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.53
|
| Rate for Payer: Multiplan PHCS |
$38.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.20
|
| Rate for Payer: UHCCP Medicaid |
$22.60
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$64.57
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Anthem Medicaid |
$22.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.36
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Cigna Commercial |
$53.59
|
| Rate for Payer: First Health Commercial |
$61.34
|
| Rate for Payer: Humana Commercial |
$54.88
|
| Rate for Payer: Humana KY Medicaid |
$22.21
|
| Rate for Payer: Kentucky WC Medicaid |
$22.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.82
|
| Rate for Payer: Ohio Health Group HMO |
$48.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.02
|
| Rate for Payer: PHCS Commercial |
$61.99
|
| Rate for Payer: United Healthcare All Payer |
$56.82
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$139.08
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
25002216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$133.52 |
| Rate for Payer: Anthem Medicaid |
$47.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.48
|
| Rate for Payer: Cash Price |
$69.54
|
| Rate for Payer: Cigna Commercial |
$115.44
|
| Rate for Payer: First Health Commercial |
$132.13
|
| Rate for Payer: Humana Commercial |
$118.22
|
| Rate for Payer: Humana KY Medicaid |
$47.83
|
| Rate for Payer: Kentucky WC Medicaid |
$48.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.39
|
| Rate for Payer: Ohio Health Group HMO |
$104.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.11
|
| Rate for Payer: PHCS Commercial |
$133.52
|
| Rate for Payer: United Healthcare All Payer |
$122.39
|
| Rate for Payer: Aetna Commercial |
$107.09
|
|
