|
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 |
$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 INTUTRK 20-20-55L STR
|
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
|
|
|
LIMITED SKULL LESS THAN 4V
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
LIMITED SKULL LESS THAN 4V
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$54.88
|
| Rate for Payer: Ambetter Exchange |
$32.42
|
| Rate for Payer: Anthem Medicaid |
$27.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.90
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$32.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.83
|
| Rate for Payer: Molina Healthcare Passport |
$27.28
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.15
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.42
|
|
|
LIMITED SKULL LESS THAN 4V
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
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: Ambetter Exchange |
$32.42
|
| Rate for Payer: Anthem Medicaid |
$27.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$32.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| 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 |
$42.15
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.42
|
|
|
LIMITED SKULL LESS THAN 4V(T
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
320T0017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
LIMITED SKULL LESS THAN 4V(T
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
320T0017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
LINAR 8 CONTACT LEAD TRIA 50CM
|
Facility
|
OP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem Medicaid |
$2,758.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Humana KY Medicaid |
$2,758.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
|
LINAR 8 CONTACT LEAD TRIA 50CM
|
Facility
|
IP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
|
LINAR ST 8 CONTCT LEAD 50CM KT
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
LINAR ST 8 CONTCT LEAD 50CM KT
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
LINAR ST 8 CONTCT LEAD 70CM KT
|
Facility
|
IP
|
$9,832.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.84 |
| Max. Negotiated Rate |
$9,439.49 |
| Rate for Payer: Aetna Commercial |
$7,571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,669.58
|
| Rate for Payer: Cash Price |
$4,916.40
|
| Rate for Payer: Cigna Commercial |
$8,161.22
|
| Rate for Payer: First Health Commercial |
$9,341.16
|
| Rate for Payer: Humana Commercial |
$8,357.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,062.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,256.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,652.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,374.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,866.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,554.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,784.63
|
| Rate for Payer: PHCS Commercial |
$9,439.49
|
| Rate for Payer: United Healthcare All Payer |
$8,652.86
|
|
|
LINAR ST 8 CONTCT LEAD 70CM KT
|
Facility
|
OP
|
$9,832.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.84 |
| Max. Negotiated Rate |
$9,439.49 |
| Rate for Payer: Aetna Commercial |
$7,571.26
|
| Rate for Payer: Anthem Medicaid |
$3,381.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,669.58
|
| Rate for Payer: Cash Price |
$4,916.40
|
| Rate for Payer: Cigna Commercial |
$8,161.22
|
| Rate for Payer: First Health Commercial |
$9,341.16
|
| Rate for Payer: Humana Commercial |
$8,357.88
|
| Rate for Payer: Humana KY Medicaid |
$3,381.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,415.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,062.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,256.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,449.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,652.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,374.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,866.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,554.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,784.63
|
| Rate for Payer: PHCS Commercial |
$9,439.49
|
| Rate for Payer: United Healthcare All Payer |
$8,652.86
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$139.08
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
25002216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.72 |
| Max. Negotiated Rate |
$133.52 |
| Rate for Payer: Aetna Commercial |
$107.09
|
| 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 |
$111.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.97
|
| Rate for Payer: PHCS Commercial |
$133.52
|
| Rate for Payer: United Healthcare All Payer |
$122.39
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Professional
|
Both
|
$69.54
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$14.13
|
| Rate for Payer: Ambetter Exchange |
$5.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.73
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.61
|
| Rate for Payer: Multiplan PHCS |
$41.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.29
|
| Rate for Payer: UHCCP Medicaid |
$24.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.61
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$69.54
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
636T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.24
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cigna Commercial |
$57.72
|
| Rate for Payer: First Health Commercial |
$66.06
|
| Rate for Payer: Humana Commercial |
$59.11
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Kentucky WC Medicaid |
$24.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.20
|
| Rate for Payer: Ohio Health Group HMO |
$52.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.98
|
| Rate for Payer: PHCS Commercial |
$66.76
|
| Rate for Payer: United Healthcare All Payer |
$61.20
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$69.54
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.24
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cigna Commercial |
$57.72
|
| Rate for Payer: First Health Commercial |
$66.06
|
| Rate for Payer: Humana Commercial |
$59.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.20
|
| Rate for Payer: Ohio Health Group HMO |
$52.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.98
|
| Rate for Payer: PHCS Commercial |
$66.76
|
| Rate for Payer: United Healthcare All Payer |
$61.20
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$139.08
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
25002216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.72 |
| Max. Negotiated Rate |
$133.52 |
| Rate for Payer: Aetna Commercial |
$107.09
|
| 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: 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: Ohio Health Choice Commercial |
$122.39
|
| Rate for Payer: Ohio Health Group HMO |
$104.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.97
|
| Rate for Payer: PHCS Commercial |
$133.52
|
| Rate for Payer: United Healthcare All Payer |
$122.39
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$69.54
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
636T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.24
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cigna Commercial |
$57.72
|
| Rate for Payer: First Health Commercial |
$66.06
|
| Rate for Payer: Humana Commercial |
$59.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.20
|
| Rate for Payer: Ohio Health Group HMO |
$52.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.98
|
| Rate for Payer: PHCS Commercial |
$66.76
|
| Rate for Payer: United Healthcare All Payer |
$61.20
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$69.54
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.24
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cigna Commercial |
$57.72
|
| Rate for Payer: First Health Commercial |
$66.06
|
| Rate for Payer: Humana Commercial |
$59.11
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Kentucky WC Medicaid |
$24.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.20
|
| Rate for Payer: Ohio Health Group HMO |
$52.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.98
|
| Rate for Payer: PHCS Commercial |
$66.76
|
| Rate for Payer: United Healthcare All Payer |
$61.20
|
|
|
LINEAR 8 CONTACT LEAD 50CM KT
|
Facility
|
IP
|
$9,832.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.84 |
| Max. Negotiated Rate |
$9,439.49 |
| Rate for Payer: Aetna Commercial |
$7,571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,669.58
|
| Rate for Payer: Cash Price |
$4,916.40
|
| Rate for Payer: Cigna Commercial |
$8,161.22
|
| Rate for Payer: First Health Commercial |
$9,341.16
|
| Rate for Payer: Humana Commercial |
$8,357.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,062.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,256.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,652.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,374.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,866.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,554.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,784.63
|
| Rate for Payer: PHCS Commercial |
$9,439.49
|
| Rate for Payer: United Healthcare All Payer |
$8,652.86
|
|
|
LINEAR 8 CONTACT LEAD 50CM KT
|
Facility
|
OP
|
$9,832.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.84 |
| Max. Negotiated Rate |
$9,439.49 |
| Rate for Payer: Aetna Commercial |
$7,571.26
|
| Rate for Payer: Anthem Medicaid |
$3,381.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,669.58
|
| Rate for Payer: Cash Price |
$4,916.40
|
| Rate for Payer: Cigna Commercial |
$8,161.22
|
| Rate for Payer: First Health Commercial |
$9,341.16
|
| Rate for Payer: Humana Commercial |
$8,357.88
|
| Rate for Payer: Humana KY Medicaid |
$3,381.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,415.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,062.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,256.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,449.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,652.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,374.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,866.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,554.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,784.63
|
| Rate for Payer: PHCS Commercial |
$9,439.49
|
| Rate for Payer: United Healthcare All Payer |
$8,652.86
|
|
|
LINEAR ST 8 CONT TRIAL LD 50CM
|
Facility
|
OP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem Medicaid |
$2,758.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Humana KY Medicaid |
$2,758.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
|
LINEAR ST 8 CONT TRIAL LD 50CM
|
Facility
|
IP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
