|
LUTONIX DCB 5*220 5F
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
LUTONIX DCB 5*220 5F
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
LUTONIX DCB 5*40*130
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
|
|
LUTONIX DCB 5*40*130
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
LUTONIX DCB 5*60*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 5*60*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 5*80*130
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
LUTONIX DCB 5*80*130
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
LUTONIX DCB 6*100*130
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
LUTONIX DCB 6*100*130
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
LUTONIX DCB 6*120*130
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 6*120*130
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 6*150*130
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 6*150*130
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 6*220 5F
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
LUTONIX DCB 6*220 5F
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
LUTONIX DCB 6*40*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 6*40*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 6*60*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 6*60*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 6*80*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 6*80*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
LUTONIX DCB 7*100 5F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 7*100 5F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LUTONIX DCB 7*150 5F
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
