|
LIVER ULTRASOUND ONLY LTD
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem Medicaid |
$379.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Humana KY Medicaid |
$379.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
LIVER ULTRASOUND ONLY LTD
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,104.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$662.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.80
|
| Rate for Payer: UHCCP Medicaid |
$386.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
LIVER ULTRASOUND ONLY LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
LIVER ULTRASOUND ONLY LTD(T
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.27 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
LIVER ULTRASOUND ONLY LTD(T
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem Medicaid |
$336.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Humana KY Medicaid |
$336.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$340.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
LIVER WEDGE BIOPSY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
76101948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LIVER WEDGE BIOPSY
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
76101948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.59 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$1,188.16
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,102.00
|
| Rate for Payer: Healthspan PPO |
$1,002.00
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,063.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
|
|
LIVER WEDGE BIOPSY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
76101948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LIVER WEDGE BIOPSY(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
761P1948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.59 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$1,188.16
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,102.00
|
| Rate for Payer: Healthspan PPO |
$1,002.00
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,063.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
|
|
LMH IMPLANTS SIZES 1
|
Facility
|
IP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LMH IMPLANTS SIZES 1
|
Facility
|
OP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem Medicaid |
$5,986.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Humana KY Medicaid |
$5,986.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,047.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,106.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LMH IMPLANTS SIZES 2
|
Facility
|
IP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LMH IMPLANTS SIZES 2
|
Facility
|
OP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem Medicaid |
$5,986.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Humana KY Medicaid |
$5,986.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,047.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,106.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LMH IMPLANTS SIZES 3
|
Facility
|
OP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem Medicaid |
$5,986.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Humana KY Medicaid |
$5,986.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,047.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,106.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LMH IMPLANTS SIZES 3
|
Facility
|
IP
|
$17,408.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.09 |
| Max. Negotiated Rate |
$16,712.06 |
| Rate for Payer: Aetna Commercial |
$13,404.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,578.55
|
| Rate for Payer: Cash Price |
$8,704.20
|
| Rate for Payer: Cigna Commercial |
$14,448.97
|
| Rate for Payer: First Health Commercial |
$16,537.98
|
| Rate for Payer: Humana Commercial |
$14,797.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,274.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,847.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,222.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,319.39
|
| Rate for Payer: Ohio Health Group HMO |
$13,056.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.60
|
| Rate for Payer: PHCS Commercial |
$16,712.06
|
| Rate for Payer: United Healthcare All Payer |
$15,319.39
|
|
|
LNR ACE DURALOC 36MM+4
|
Facility
|
OP
|
$15,699.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.93 |
| Max. Negotiated Rate |
$15,071.50 |
| Rate for Payer: Aetna Commercial |
$12,088.60
|
| Rate for Payer: Anthem Medicaid |
$5,399.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.59
|
| Rate for Payer: Cash Price |
$7,849.74
|
| Rate for Payer: Cigna Commercial |
$13,030.57
|
| Rate for Payer: First Health Commercial |
$14,914.51
|
| Rate for Payer: Humana Commercial |
$13,344.56
|
| Rate for Payer: Humana KY Medicaid |
$5,399.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,507.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.54
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.84
|
| Rate for Payer: PHCS Commercial |
$15,071.50
|
| Rate for Payer: United Healthcare All Payer |
$13,815.54
|
|
|
LNR ACE DURALOC 36MM+4
|
Facility
|
IP
|
$15,699.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.93 |
| Max. Negotiated Rate |
$15,071.50 |
| Rate for Payer: Aetna Commercial |
$12,088.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.59
|
| Rate for Payer: Cash Price |
$7,849.74
|
| Rate for Payer: Cigna Commercial |
$13,030.57
|
| Rate for Payer: First Health Commercial |
$14,914.51
|
| Rate for Payer: Humana Commercial |
$13,344.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.54
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.84
|
| Rate for Payer: PHCS Commercial |
$15,071.50
|
| Rate for Payer: United Healthcare All Payer |
$13,815.54
|
|
|
LNT IMPLANT SYSTEM 4.75 BC SW
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
LNT IMPLANT SYSTEM 4.75 BC SW
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$23,250.18
|
|
|
Service Code
|
MSDRG 496
|
| Min. Negotiated Rate |
$15,776.91 |
| Max. Negotiated Rate |
$23,250.18 |
| Rate for Payer: Anthem Medicaid |
$15,776.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,607.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,250.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,419.81
|
| Rate for Payer: Humana KY Medicaid |
$15,776.91
|
| Rate for Payer: Humana Medicare Advantage |
$16,607.27
|
| Rate for Payer: Kentucky WC Medicaid |
$15,934.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,928.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,092.44
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$41,893.60
|
|
|
Service Code
|
MSDRG 495
|
| Min. Negotiated Rate |
$28,427.80 |
| Max. Negotiated Rate |
$41,893.60 |
| Rate for Payer: Anthem Medicaid |
$28,427.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,924.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,893.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$40,397.40
|
| Rate for Payer: Humana KY Medicaid |
$28,427.80
|
| Rate for Payer: Humana Medicare Advantage |
$29,924.00
|
| Rate for Payer: Kentucky WC Medicaid |
$28,712.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,908.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,996.36
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$16,698.02
|
|
|
Service Code
|
MSDRG 497
|
| Min. Negotiated Rate |
$11,330.80 |
| Max. Negotiated Rate |
$16,698.02 |
| Rate for Payer: Anthem Medicaid |
$11,330.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,927.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,698.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,101.67
|
| Rate for Payer: Humana KY Medicaid |
$11,330.80
|
| Rate for Payer: Humana Medicare Advantage |
$11,927.16
|
| Rate for Payer: Kentucky WC Medicaid |
$11,444.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,312.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,557.42
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$30,544.00
|
|
|
Service Code
|
MSDRG 498
|
| Min. Negotiated Rate |
$20,726.28 |
| Max. Negotiated Rate |
$30,544.00 |
| Rate for Payer: Anthem Medicaid |
$20,726.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21,817.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30,544.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$29,453.14
|
| Rate for Payer: Humana KY Medicaid |
$20,726.28
|
| Rate for Payer: Humana Medicare Advantage |
$21,817.14
|
| Rate for Payer: Kentucky WC Medicaid |
$20,933.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,180.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,140.81
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$15,088.36
|
|
|
Service Code
|
MSDRG 499
|
| Min. Negotiated Rate |
$10,238.53 |
| Max. Negotiated Rate |
$15,088.36 |
| Rate for Payer: Anthem Medicaid |
$10,238.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,777.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,088.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,549.49
|
| Rate for Payer: Humana KY Medicaid |
$10,238.53
|
| Rate for Payer: Humana Medicare Advantage |
$10,777.40
|
| Rate for Payer: Kentucky WC Medicaid |
$10,340.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,932.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,443.30
|
|
|
LOCATOR PLUS 1281/52
|
Facility
|
OP
|
$1,822.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
