|
LIVER ULTRASOUND ONLY LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
LIVER ULTRASOUND ONLY LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
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: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| 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 |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
LIVER ULTRASOUND ONLY LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
LIVER ULTRASOUND ONLY LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
LIVER WEDGE BIOPSY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
76101948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LIVER WEDGE BIOPSY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
76101948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| 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 |
$1,188.16 |
| Rate for Payer: Aetna Commercial |
$1,188.16
|
| Rate for Payer: Ambetter Exchange |
$806.62
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$806.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$806.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$967.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$806.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.62
|
| 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 |
$1,048.61
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$806.62
|
|
|
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 |
$1,188.16 |
| Rate for Payer: Aetna Commercial |
$1,188.16
|
| Rate for Payer: Ambetter Exchange |
$806.62
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$806.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$806.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$967.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$806.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.62
|
| 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 |
$1,048.61
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$806.62
|
|
|
LMH IMPLANTS SIZES 1
|
Facility
|
IP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LMH IMPLANTS SIZES 1
|
Facility
|
OP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem Medicaid |
$6,181.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Humana KY Medicaid |
$6,181.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,244.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,305.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LMH IMPLANTS SIZES 2
|
Facility
|
IP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LMH IMPLANTS SIZES 2
|
Facility
|
OP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem Medicaid |
$6,181.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Humana KY Medicaid |
$6,181.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,244.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,305.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LMH IMPLANTS SIZES 3
|
Facility
|
IP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LMH IMPLANTS SIZES 3
|
Facility
|
OP
|
$17,975.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,392.59 |
| Max. Negotiated Rate |
$17,256.29 |
| Rate for Payer: Aetna Commercial |
$13,840.98
|
| Rate for Payer: Anthem Medicaid |
$6,181.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,020.73
|
| Rate for Payer: Cash Price |
$8,987.65
|
| Rate for Payer: Cigna Commercial |
$14,919.50
|
| Rate for Payer: First Health Commercial |
$17,076.53
|
| Rate for Payer: Humana Commercial |
$15,279.00
|
| Rate for Payer: Humana KY Medicaid |
$6,181.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,244.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,739.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,265.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,392.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,305.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,818.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,481.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,380.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,638.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,402.96
|
| Rate for Payer: PHCS Commercial |
$17,256.29
|
| Rate for Payer: United Healthcare All Payer |
$15,818.26
|
|
|
LNR ACE DURALOC 36MM+4
|
Facility
|
IP
|
$16,218.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.67 |
| Max. Negotiated Rate |
$15,570.15 |
| Rate for Payer: Aetna Commercial |
$12,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,650.75
|
| Rate for Payer: Cash Price |
$8,109.46
|
| Rate for Payer: Cigna Commercial |
$13,461.70
|
| Rate for Payer: First Health Commercial |
$15,407.96
|
| Rate for Payer: Humana Commercial |
$13,786.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,299.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,969.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,865.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,164.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,975.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,110.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,191.05
|
| Rate for Payer: PHCS Commercial |
$15,570.15
|
| Rate for Payer: United Healthcare All Payer |
$14,272.64
|
|
|
LNR ACE DURALOC 36MM+4
|
Facility
|
OP
|
$16,218.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,865.67 |
| Max. Negotiated Rate |
$15,570.15 |
| Rate for Payer: Aetna Commercial |
$12,488.56
|
| Rate for Payer: Anthem Medicaid |
$5,577.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,650.75
|
| Rate for Payer: Cash Price |
$8,109.46
|
| Rate for Payer: Cigna Commercial |
$13,461.70
|
| Rate for Payer: First Health Commercial |
$15,407.96
|
| Rate for Payer: Humana Commercial |
$13,786.07
|
| Rate for Payer: Humana KY Medicaid |
$5,577.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,634.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,299.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,969.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,865.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,689.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,164.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,975.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,110.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,191.05
|
| Rate for Payer: PHCS Commercial |
$15,570.15
|
| Rate for Payer: United Healthcare All Payer |
$14,272.64
|
|
|
LNT IMPLANT SYSTEM 4.75 BC SW
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
LNT IMPLANT SYSTEM 4.75 BC SW
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
LOCATOR PLUS 1281/52
|
Facility
|
OP
|
$1,813.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LOCATOR PLUS 1281/52
|
Facility
|
IP
|
$1,813.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LOCKING SCREW
|
Facility
|
IP
|
$1,706.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.98 |
| Max. Negotiated Rate |
$1,638.34 |
| Rate for Payer: Aetna Commercial |
$1,314.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.15
|
| Rate for Payer: Cash Price |
$853.30
|
| Rate for Payer: Cigna Commercial |
$1,416.48
|
| Rate for Payer: First Health Commercial |
$1,621.27
|
| Rate for Payer: Humana Commercial |
$1,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.55
|
| Rate for Payer: PHCS Commercial |
$1,638.34
|
| Rate for Payer: United Healthcare All Payer |
$1,501.81
|
|
|
LOCKING SCREW
|
Facility
|
OP
|
$1,706.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.98 |
| Max. Negotiated Rate |
$1,638.34 |
| Rate for Payer: Aetna Commercial |
$1,314.08
|
| Rate for Payer: Anthem Medicaid |
$586.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.15
|
| Rate for Payer: Cash Price |
$853.30
|
| Rate for Payer: Cigna Commercial |
$1,416.48
|
| Rate for Payer: First Health Commercial |
$1,621.27
|
| Rate for Payer: Humana Commercial |
$1,450.61
|
| Rate for Payer: Humana KY Medicaid |
$586.90
|
| Rate for Payer: Kentucky WC Medicaid |
$592.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.55
|
| Rate for Payer: PHCS Commercial |
$1,638.34
|
| Rate for Payer: United Healthcare All Payer |
$1,501.81
|
|
|
LOCKING SCREW 3.5*12MM
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
LOCKING SCREW 3.5*12MM
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
