Price Transparency - Lincoln Health

IF YOU ARE COVERED BY HEALTH INSURANCE, YOU ARE STRONGLY ENCOURAGED TO CONSULT WITH YOUR HEALTH INSURER TO DETERMINE ACCURATE INFORMATION ABOUT YOUR FINANCIAL RESPONSIBILITY FOR A PARTICULAR HEALTH CARE SERVICE PROVIDED AT LINCOLN COMMUNITY HOSPITAL, CLINICS OR CARE CENTER. IF YOU ARE NOT COVERED BY HEALTH INSURANCE, YOU ARE STRONGLY ENCOURAGED TO CONTACT OUR BUSINESS OFFICE AT 719-743-2421 ext 3222 TO DISCUSS PAYMENT OPTIONS PRIOR TO RECEIVING A HEALTH CARE SERVICE FROM THIS HEALTH CARE FACILITY SINCE POSTED HEALTH CARE PRICES MAY NOT REFLECT THE ACTUAL AMOUNT OF YOUR FINANCIAL RESPONSIBILITY.

36415	Lab- Veinpuncture	$20.00
85025	Lab-Complete Blood Count	$43.00
80048	Lab-Basic Metabolic Panel	$125.00
80053	Lab-Comprehensive Metabolic Panel	$145.00
97162	Physical Therapy- PT Evaluation Moderate	$150.00
71020	Radiology- Chest 2 View X-Ray	$295.00
97110	Physical Therapy- Therapeutic Exercise 15 minute session	$70.00
97530	Physical Therapy- Functional Evaluation 15 minute session	$70.00
83880	Lab-B Type Natriuretic Peptide (BNP)	$85.00
81001	Lab-Routine UA	$18.00
93005	Radiology-Electrocardiogram (EKG)	$225.00
85610	Lab-Protime	$45.00
97116	Physical Therapy-Gait Training (Complex) 15 minute session	$70.00
97165	Occupational Therapy-Evaluation Low Complexity	$150.00
97166	Occupational Therapy-Evaluation Moderate Complexity	$150.00
97535	Physical Therapy-Activites/ Daily Living Evaluation	$70.00
84512	Lab- Troponin	$155.00
83735	Lab- Magnesium Test	$45.00
97161	Physical Therapy- PT Evaluation Low Complexity	$150.00
87086	Lab-Urine Culture	$29.70
84443	Lab-Thyroid Stimulating Hormone (THS)	$65.00
87040	Lab-Aerobic/ Anaerobic Blood Culture	$145.00
82270	Lab-Hemoculture	$30.00
80202	Lab-Vancomycin Peak Test	$0.00
36592	Lab-IV PICC Line Insertion	$125.00
83605	Lab-Lactate	$110.00
93307	Radiology-Echocardiogram Complete	$1575.00
94762	Respiratory Therapy-Pulse Ox/O2 Saturation	$21.60
85379	Lab-D-Dimer	$165.00
83036	Lab-Hemoglobin A1c	$125.00

99214	Clinic – Office Visit Established Patient, Level 2	$210.00
85025	Lab-Complete Blood Count	$43.00
80053	Lab – Comprehensive Metabolic Panel	$145.00
99213	Clinic – Office Visit Established Patient, Level 3	$135.00
99211	Clinic – Office Visit Established Patient, Level 1	$150.00
85610	Lab – Protime	$45.00
80061	Lap Lipid Profile	$65.00
96372	ER Injection	$27.00
99283	ER Level 3 ER Visit	$805.00
90471	Clinic-Immunization Administration Fee	$8.00
90832	Behavioral Health- 30 minute Individual Session	$70.00
93005	Radiology- Diagnostic Electrocardiogram (EKG)	$225.00
36592	Lab- Blood Draw	$125.00
71020	Radiology- Chest Tube View X-Ray	$295.00
99284	ER- Level 4 ER Visit	$1314.00
99201	Clinic-Office Visit New Patient Level 1	$100.00
90656	Pharmacy- Flu Vaccination	$25.00
96365	ER-IV Infusion First Hour	$343.00
97140	Physical Therapy- Manual Therapeutic Exercise 15 minute session	$70.00
96374	ER-IV Push-initial	$65.00
99080	Clinic-Office Visit- CDL Physical	$50.00
81003	Lab-Dipstick-UA Only	$8.00
99336	Office Visit – Assisted Care Established Patient Moderate Complexity	$80.00
97162	Physical Therapy- Evaluation Moderate Complexity	$150.00
99282	ER-Level 2 ER Visit	$404.00
90853	Behavioral Health- Group Counseling Session	$31.00
G0103	Lab-Prostate Specific Antigen Screening (Annually)	$62.00
87430	Lab-Rapid Group A	$18.00
96375	ER-IV Infuison Additional After First Hour	$27.00

Our goal is to provide meaningful and reliable information to help you understand prices in advance of your procedure. We have put together the top inpatient and outpatient procedure costs for self-pay individuals to give you an estimate of the expected pricing for commonly provided health care services at Lincoln Health.

Actual prices on your final bill may vary from this information based on the patient’s medical condition, unknown circumstances or complications, final diagnosis, and recommended treatment ordered by the attending physician(s). Please be advised that while the hospital/clinic attempts to estimate the prices of care as accurately as possible, there may be significant variations between the prices listed and the actual price reflected on your final bill.

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S	T
1	CDM Item Number	Revenue Code	Service ID	Service Description	Gross Charge	Discounted Cash Price	Minimum Negotiated Charge	Maximum Negotiated Charge	Payer Negotiated Charge: Aetna (Plan: Default)	Payer Negotiated Charge: Blue Cross Blue Shield of CO (Plan: Default)	Payer Negotiated Charge: Bright Health Plan (Plan: Default)	Payer Negotiated Charge: Cigna (Plan: Default)	Payer Negotiated Charge: Friday Health Plans of Colorado Inc (Plan: Default)	Payer Negotiated Charge: Great West Healthcare (Plan: Default)	Payer Negotiated Charge: Humana (Plan: Default)	Payer Negotiated Charge: Humana (Plan: Medicare Advantage)	Payer Negotiated Charge: Rocky Mountain Health Plan (Plan: Default)	Payer Negotiated Charge: Rocky Mountain Health Plan (Plan: Medicare Advantage)	Payer Negotiated Charge: United Healthcare (Plan: Default)	Payer Negotiated Charge: United Healthcare (Plan: Medicare Advantage)
2	3010007	270		TOURNIQUET	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
3	3010008	276		INTRAOCULAR LENS (IOL)	289	289
4	3010009	270		CHEST TUBE INSERTION TRAY	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
5	3010010	270		BATH SPONGE W/HANDLE	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
6	3010011	270		COMPRESSION DEVICE	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
7	3010012	270		SEALEASY KIT	91	91	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
8	3010013	270		YANKAUER VENTED	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
9	3010014	270		MEDSYSTEM TUBING	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
10	3010018	270		PROTIME STRIP	48	48	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
11	3010019	270	A6456	UNNA BOOT	69	69
12	3010020	270		PROBE DISP	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
13	3010021	270		HYBRESIS PATCH	90	90	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
14	3010025	270	L4350	AIR STIRRUP	237	237
15	3010029	270	A4565	ARM SLING MD	38	38	23.56	23.56											23.56
16	3010030	270		MECONIUM ASPIRATOR	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
17	3010031	270		MASK C-PAP MD 1/2	492	492	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
18	3010033	270		THUMB SPICA RIGHT	69	69	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
19	3010034	270		DUPEL ELECTRODES	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
20	3010035	270		PEAK FLOW METER	100	100	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
21	3010036	278	C1751	POWER PICC	1279	1279
22	3010038	270		ENDO SPATULA	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
23	3010039	270		ENDO PISTOL	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
24	3010040	270		THERACANE	126	126	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
25	3010041	270		THERABAND	9	9	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
26	3010042	270		MAX CORE	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
27	3010043	270		WAFFLE BOOT	182	182	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
28	3010044	270		DECLOGGER 18-24FR	50	50	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
29	3010045	270		DECLOGGER 20-22FR	63	63	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
30	3010046	270		DINAMAP	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
31	3010047	270		BITE STICK	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
32	3010048	270		TOURNIQUET/ 15 MINUTES	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
33	3010049	270		OSTOMY WAFER	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
34	3010050	279		REACHER/ GRABBER	74	74	0	0								0
35	3010051	270		STOMAHESIVE PASTE [20 OZ]	51	51	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
36	3010052	270		POLYDERM	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
37	3010053	270		EPISTAXIS KIT	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
38	3010054	270		CERVICAL TRACTION UNIT	226	226	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
39	3010055	271		KNUCKLE BENDER	223	223	38.86	38.86									38.86
40	3010056	270		ACAPELLA	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
41	3010057	270		MEPILEX/BORDER 4X4	48	48	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
42	3010058	270		MEPILEX 4X4	44	44	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
43	3010059	270		PLEURX DRAIN	447	447	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
44	3010060	270		ENDO FAN 10MM	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
45	3010061	270		PNEUMOTHORAX 14G	88	88	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
46	3010062	270		AED PED PAD	466	466	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
47	3010063	270		CPAP AMBULANCE	265	265	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
48	3010064	270	A4629	TRACHEOSTOMY CARE KIT	31	31
49	3010065	270		DRAPE MINOR PROCEDURE	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
50	3010066	270	A4649	SUTURE CHROM 5-0 687G	70	70	0	135.04				0		0					135.04
51	3010067	270	A4649	SUTURE VICRYL O J978	19	19	0	135.04				0		0					135.04
52	3010068	270	A4649	SUTURE VICRYL 2-0 J269-87	18	18	0	135.04				0		0					135.04
53	3010070	270	A4649	SUTURE VICRYL 5-0 J495	39	39	0	135.04				0		0					135.04
54	3010071	270	A4649	SUTURE ETHILON 3-0 669	19	19	0	135.04				0		0					135.04
55	3010072	270	A4649	SUTURE ETHILON 3-0 663	19	19	0	135.04				0		0					135.04
56	3010073	270	A4649	SUTURE PROLENE 0 8434	23	23	0	135.04				0		0					135.04
57	3010074	270	A4649	SUTURE PROLENE 5-0 8605	37	37	0	135.04				0		0					135.04
58	3010075	270	A4649	SUTURE ETHILON 3-0 669H	18	18	0	135.04				0		0					135.04
59	3010076	270	A4649	SUTURE ETHILON 3-0 663H	69	69	0	135.04				0		0					135.04
60	3010077	270	A4649	SUTURE PROLENE 0 8434H	24	24	0	135.04				0		0					135.04
61	3010078	270	A4649	SUTURE VICRYL 0 J978H	18	18	0	135.04				0		0					135.04
62	3010079	270	A4649	SUTURE VICRYL 2-0 J269H	17	17	0	135.04				0		0					135.04
63	3010081	270	A4649	SUTURE CHROMIC 687G	63	63	0	135.04				0		0					135.04
64	3010082	270		TOE CAP/ VISCO (GEL)	29	29	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
65	3010083	270		INSOLE/ FULL LENGTH GEL	182	182	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
66	3010084	270		EXTENSION SET (MICRO)	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
67	3010085	270		ELECTRODE/ STANDRD NEEDLE	37	37	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
68	3010086	270		DRAPE/ FENESTRATION	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
69	3010087	270		CATH CLEAN	25	25	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
70	3010088	270		TENDER GRIP	14	14	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
71	3010089	270		DEPENDS SLIP-ON MEDIUM	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
72	3010090	270		CANNULA- ENDOBIOPSY	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
73	3010091	270		EAKIN SEAL 4"	40	40	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
74	3010092	270	L3480	TULLI HEEL CUP REG	130	130
75	3010093	270		STOMACH TUBE SUMP 10FR	48	48	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
76	3010094	270		ALLEVYN 4X4	59	59	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
77	3010095	270	A4649	SUTURE ETHILON 5.0 1666	69	69	0	135.04				0		0					135.04
78	3010096	270		SAM PELVIC SLING	486	486	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
79	3010097	270	Q4051	SAM SPLINT 36"	191	191
80	3010098	270		SAM SPLINT 18"	158	158	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
81	3010099	270		MAXORB DRESSING 2X2	27	27	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
82	3010100	270	A4649	SUTURE PROLENE 4.0 8634	69	69	0	135.04				0		0					135.04
83	3010102	270		KATZ EXTRACTOR	552	552	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
84	3010103	270		COTTON TIP APPLICATOR	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
85	3010104	270		DEPENDS - INDIVIDUAL	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
86	3010107	270		MEDIFIX (BOX)	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
87	3010116	270		CATH KIT UNIVERSAL	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
88	3010117	270		ALLEVYN HEEL 9X9	132	132	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
89	3010118	270	A6212	MEPILEX - SACRUM	90	90
90	3010119	270		MEPILEX/BORDER 3X3	48	48	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
91	3010120	270		ANTI REFLUX VALVE	121	121	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
92	3010121	270		URINAL/FEMALE	4	4	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
93	3010122	270	A4649	SUTURE VICRYL 4-0 J392H	69	69	0	135.04				0		0					135.04
94	3010123	270		MEPILEX/BORDER 1.6X2	48	48	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
95	3010125	270		GLIDE SCOPE SZ 3	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
96	3010126	270		HEEL LIFT	45	45	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
97	3010127	270		ESMARK 3"	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
98	3010128	270		OB INSTRUMENT TRAY	0	0	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
99	3010131	270		INFANT WARMER	30	30	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39
100	3010132	270		MINOR CLINIC SET	27	27	0	55.2	0			21.48	55.2	23.59		15.61	27.39		15.39

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