|
LILETTA 24HR IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
636T0070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| 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 |
$601.83
|
| 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 |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| 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 |
25002482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| 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 |
$601.83
|
| 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 |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| 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 |
$525.00 |
| 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 |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| 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 |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| 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 |
$601.83
|
| 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 |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| 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 |
636T0070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| 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 |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LIMB EXT INTUITRAK 16-16-55FL
|
Facility
|
IP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUITRAK 16-16-55FL
|
Facility
|
OP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem Medicaid |
$4,163.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Humana KY Medicaid |
$4,163.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,205.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,246.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUITRAK 20-20-55FL
|
Facility
|
IP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUITRAK 20-20-55FL
|
Facility
|
OP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem Medicaid |
$4,163.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Humana KY Medicaid |
$4,163.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,205.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,246.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUITRAK 20-25-65F
|
Facility
|
IP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUITRAK 20-25-65F
|
Facility
|
OP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem Medicaid |
$4,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Humana KY Medicaid |
$4,794.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,890.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRAK 20-25-55S SS
|
Facility
|
IP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRAK 20-25-55S SS
|
Facility
|
OP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem Medicaid |
$4,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Humana KY Medicaid |
$4,794.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,890.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRK 16-16-55L STR
|
Facility
|
IP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUTRK 16-16-55L STR
|
Facility
|
OP
|
$12,106.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.84 |
| Max. Negotiated Rate |
$11,621.90 |
| Rate for Payer: Aetna Commercial |
$9,321.74
|
| Rate for Payer: Anthem Medicaid |
$4,163.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,442.80
|
| Rate for Payer: Cash Price |
$6,053.08
|
| Rate for Payer: Cigna Commercial |
$10,048.10
|
| Rate for Payer: First Health Commercial |
$11,500.84
|
| Rate for Payer: Humana Commercial |
$10,290.23
|
| Rate for Payer: Humana KY Medicaid |
$4,163.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,205.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,927.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,934.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,631.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,246.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,653.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,079.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,684.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,532.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,353.24
|
| Rate for Payer: PHCS Commercial |
$11,621.90
|
| Rate for Payer: United Healthcare All Payer |
$10,653.41
|
|
|
LIMB EXT INTUTRK 16-16-88L STR
|
Facility
|
OP
|
$13,207.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.14 |
| Max. Negotiated Rate |
$12,678.86 |
| Rate for Payer: Aetna Commercial |
$10,169.51
|
| Rate for Payer: Anthem Medicaid |
$4,541.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,301.58
|
| Rate for Payer: Cash Price |
$6,603.58
|
| Rate for Payer: Cigna Commercial |
$10,961.93
|
| Rate for Payer: First Health Commercial |
$12,546.79
|
| Rate for Payer: Humana Commercial |
$11,226.08
|
| Rate for Payer: Humana KY Medicaid |
$4,541.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,588.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,829.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,746.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,633.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,622.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,905.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,565.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,490.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,112.93
|
| Rate for Payer: PHCS Commercial |
$12,678.86
|
| Rate for Payer: United Healthcare All Payer |
$11,622.29
|
|
|
LIMB EXT INTUTRK 16-16-88L STR
|
Facility
|
IP
|
$13,207.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.14 |
| Max. Negotiated Rate |
$12,678.86 |
| Rate for Payer: Aetna Commercial |
$10,169.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,301.58
|
| Rate for Payer: Cash Price |
$6,603.58
|
| Rate for Payer: Cigna Commercial |
$10,961.93
|
| Rate for Payer: First Health Commercial |
$12,546.79
|
| Rate for Payer: Humana Commercial |
$11,226.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,829.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,746.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,622.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,905.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,565.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,490.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,112.93
|
| Rate for Payer: PHCS Commercial |
$12,678.86
|
| Rate for Payer: United Healthcare All Payer |
$11,622.29
|
|
|
LIMB EXT INTUTRK 20-13-70FL ST
|
Facility
|
OP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem Medicaid |
$4,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Humana KY Medicaid |
$4,794.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,890.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRK 20-13-70FL ST
|
Facility
|
IP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRK 20-13-88FL LT
|
Facility
|
OP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem Medicaid |
$4,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Humana KY Medicaid |
$4,794.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,890.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
|
LIMB EXT INTUTRK 20-13-88FL LT
|
Facility
|
IP
|
$13,941.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.35 |
| Max. Negotiated Rate |
$13,383.50 |
| Rate for Payer: Aetna Commercial |
$10,734.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,874.10
|
| Rate for Payer: Cash Price |
$6,970.58
|
| Rate for Payer: Cigna Commercial |
$11,571.15
|
| Rate for Payer: First Health Commercial |
$13,244.09
|
| Rate for Payer: Humana Commercial |
$11,849.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,431.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,288.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,182.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,268.21
|
| Rate for Payer: Ohio Health Group HMO |
$10,455.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,152.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,619.39
|
| Rate for Payer: PHCS Commercial |
$13,383.50
|
| Rate for Payer: United Healthcare All Payer |
$12,268.21
|
|
