|
LUMBAR PUNCTURE DIAG
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
45000293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.42
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
LUMBAR PUNCTURE DIAG
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
76102291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$125.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$50.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,232.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$112.15
|
| Rate for Payer: Healthspan PPO |
$185.69
|
| Rate for Payer: Humana Medicaid |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.19
|
| Rate for Payer: Molina Healthcare Passport |
$50.19
|
| Rate for Payer: Multiplan PHCS |
$739.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$862.40
|
| Rate for Payer: UHCCP Medicaid |
$33.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.69
|
|
|
LUMBAR PUNCTURE DIAG(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
761P2291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$125.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$50.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$112.15
|
| Rate for Payer: Healthspan PPO |
$185.69
|
| Rate for Payer: Humana Medicaid |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.19
|
| Rate for Payer: Molina Healthcare Passport |
$50.19
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$33.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.69
|
|
|
LUMBAR PUNCTURE DIAG(T
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
761T2291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.42
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
LUMBAR PUNCTURE DIAG(T
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
761T2291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem Medicaid |
$337.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Humana KY Medicaid |
$337.71
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$341.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.42
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
LUMBAR SPINE 2-3V
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
LUMBAR SPINE 2-3V
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
LUMBAR SPINE 2-3V
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$56.01
|
| Rate for Payer: Healthspan PPO |
$54.86
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$250.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$291.90
|
| Rate for Payer: UHCCP Medicaid |
$145.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
|
|
LUMBAR SPINE 2-3V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
320P0052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$58.54 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$56.01
|
| Rate for Payer: Healthspan PPO |
$54.86
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
|
|
LUMBAR SPINE 2-3V(T
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
320T0052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
LUMBAR SPINE 2-3V(T
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
320T0052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem Medicaid |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Humana KY Medicaid |
$126.21
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
LUMBOSACRAL SPINE MIN 4VWS
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
LUMBOSACRAL SPINE MIN 4VWS
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
LUMBOSACRAL SPINE MIN 4VWS
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna Commercial |
$81.75
|
| Rate for Payer: Anthem Medicaid |
$38.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$77.30
|
| Rate for Payer: Healthspan PPO |
$76.60
|
| Rate for Payer: Humana Medicaid |
$38.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.89
|
| Rate for Payer: Molina Healthcare Passport |
$38.13
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.51
|
|
|
LUMBOSACRAL SPINE MIN 4VWS(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
320P0053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Aetna Commercial |
$81.75
|
| Rate for Payer: Anthem Medicaid |
$38.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$77.30
|
| Rate for Payer: Healthspan PPO |
$76.60
|
| Rate for Payer: Humana Medicaid |
$38.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.89
|
| Rate for Payer: Molina Healthcare Passport |
$38.13
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.51
|
|
|
LUMBOSACRAL SPINE MIN 4VWS(T
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
320T0053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LUMBOSACRAL SPINE MIN 4VWS(T
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
320T0053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LUMIGAN 0.01% EYE DROPS
|
Facility
|
IP
|
$17.13
|
|
|
Service Code
|
NDC 23320503
|
| Hospital Charge Code |
25000924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.36
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna Commercial |
$14.22
|
| Rate for Payer: First Health Commercial |
$16.27
|
| Rate for Payer: Humana Commercial |
$14.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.07
|
| Rate for Payer: Ohio Health Group HMO |
$12.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.31
|
| Rate for Payer: PHCS Commercial |
$16.44
|
| Rate for Payer: United Healthcare All Payer |
$15.07
|
|
|
LUMIGAN 0.01% EYE DROPS
|
Facility
|
OP
|
$17.13
|
|
|
Service Code
|
NDC 23320503
|
| Hospital Charge Code |
25000924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Anthem Medicaid |
$5.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.36
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna Commercial |
$14.22
|
| Rate for Payer: First Health Commercial |
$16.27
|
| Rate for Payer: Humana Commercial |
$14.56
|
| Rate for Payer: Humana KY Medicaid |
$5.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.07
|
| Rate for Payer: Ohio Health Group HMO |
$12.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.31
|
| Rate for Payer: PHCS Commercial |
$16.44
|
| Rate for Payer: United Healthcare All Payer |
$15.07
|
|
|
LUNDERQUIST TM WIRE GUIDE
|
Facility
|
OP
|
$1,561.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$1,499.04 |
| Rate for Payer: Aetna Commercial |
$1,202.36
|
| Rate for Payer: Anthem Medicaid |
$537.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.97
|
| Rate for Payer: Cash Price |
$780.75
|
| Rate for Payer: Cigna Commercial |
$1,296.04
|
| Rate for Payer: First Health Commercial |
$1,483.42
|
| Rate for Payer: Humana Commercial |
$1,327.28
|
| Rate for Payer: Humana KY Medicaid |
$537.00
|
| Rate for Payer: Kentucky WC Medicaid |
$542.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.06
|
| Rate for Payer: PHCS Commercial |
$1,499.04
|
| Rate for Payer: United Healthcare All Payer |
$1,374.12
|
|
|
LUNDERQUIST TM WIRE GUIDE
|
Facility
|
IP
|
$1,561.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$1,499.04 |
| Rate for Payer: Aetna Commercial |
$1,202.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.97
|
| Rate for Payer: Cash Price |
$780.75
|
| Rate for Payer: Cigna Commercial |
$1,296.04
|
| Rate for Payer: First Health Commercial |
$1,483.42
|
| Rate for Payer: Humana Commercial |
$1,327.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.06
|
| Rate for Payer: PHCS Commercial |
$1,499.04
|
| Rate for Payer: United Healthcare All Payer |
$1,374.12
|
|
|
LUNDERQUIST WIRE 260CM SS
|
Facility
|
OP
|
$1,965.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.49 |
| Max. Negotiated Rate |
$1,886.69 |
| Rate for Payer: Aetna Commercial |
$1,513.28
|
| Rate for Payer: Anthem Medicaid |
$675.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.93
|
| Rate for Payer: Cash Price |
$982.65
|
| Rate for Payer: Cigna Commercial |
$1,631.20
|
| Rate for Payer: First Health Commercial |
$1,867.04
|
| Rate for Payer: Humana Commercial |
$1,670.50
|
| Rate for Payer: Humana KY Medicaid |
$675.87
|
| Rate for Payer: Kentucky WC Medicaid |
$682.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.24
|
| Rate for Payer: PHCS Commercial |
$1,886.69
|
| Rate for Payer: United Healthcare All Payer |
$1,729.46
|
|
|
LUNDERQUIST WIRE 260CM SS
|
Facility
|
IP
|
$1,965.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.49 |
| Max. Negotiated Rate |
$1,886.69 |
| Rate for Payer: Aetna Commercial |
$1,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.93
|
| Rate for Payer: Cash Price |
$982.65
|
| Rate for Payer: Cigna Commercial |
$1,631.20
|
| Rate for Payer: First Health Commercial |
$1,867.04
|
| Rate for Payer: Humana Commercial |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.24
|
| Rate for Payer: PHCS Commercial |
$1,886.69
|
| Rate for Payer: United Healthcare All Payer |
$1,729.46
|
|
|
LUNDRQST WR TSCMG-35-300-LESDC
|
Facility
|
OP
|
$1,739.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.10 |
| Max. Negotiated Rate |
$1,669.63 |
| Rate for Payer: Aetna Commercial |
$1,339.18
|
| Rate for Payer: Anthem Medicaid |
$598.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.58
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cigna Commercial |
$1,443.54
|
| Rate for Payer: First Health Commercial |
$1,652.24
|
| Rate for Payer: Humana Commercial |
$1,478.32
|
| Rate for Payer: Humana KY Medicaid |
$598.11
|
| Rate for Payer: Kentucky WC Medicaid |
$604.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.15
|
| Rate for Payer: PHCS Commercial |
$1,669.63
|
| Rate for Payer: United Healthcare All Payer |
$1,530.50
|
|
|
LUNDRQST WR TSCMG-35-300-LESDC
|
Facility
|
IP
|
$1,739.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.10 |
| Max. Negotiated Rate |
$1,669.63 |
| Rate for Payer: Aetna Commercial |
$1,339.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.58
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cigna Commercial |
$1,443.54
|
| Rate for Payer: First Health Commercial |
$1,652.24
|
| Rate for Payer: Humana Commercial |
$1,478.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.15
|
| Rate for Payer: PHCS Commercial |
$1,669.63
|
| Rate for Payer: United Healthcare All Payer |
$1,530.50
|
|
