|
SPHINCTEROPLASTY(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
761P1934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,080.52
|
| Rate for Payer: Anthem Medicaid |
$406.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$990.06
|
| Rate for Payer: Healthspan PPO |
$911.22
|
| Rate for Payer: Humana Medicaid |
$406.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.38
|
| Rate for Payer: Molina Healthcare Passport |
$406.25
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.31
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.75
|
| Rate for Payer: Anthem Medicaid |
$136.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$212.14
|
| Rate for Payer: Healthspan PPO |
$269.72
|
| Rate for Payer: Humana Medicaid |
$136.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.27
|
| Rate for Payer: Molina Healthcare Passport |
$136.54
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$134.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.91
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
761P1913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.75
|
| Rate for Payer: Anthem Medicaid |
$136.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$212.14
|
| Rate for Payer: Healthspan PPO |
$269.72
|
| Rate for Payer: Humana Medicaid |
$136.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.27
|
| Rate for Payer: Molina Healthcare Passport |
$136.54
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$134.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.91
|
|
|
SPIDER FX 3MM
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SPIDER FX 3MM
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SPIDER FX 4MM
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SPIDER FX 4MM
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SPIDER FX 5MM
|
Facility
|
IP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPIDER FX 5MM
|
Facility
|
OP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem Medicaid |
$4,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Humana KY Medicaid |
$4,015.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,056.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,096.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPIDER FX 6MM
|
Facility
|
IP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPIDER FX 6MM
|
Facility
|
OP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem Medicaid |
$4,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Humana KY Medicaid |
$4,015.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,056.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,096.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPIDER FX 7MM
|
Facility
|
IP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPIDER FX 7MM
|
Facility
|
OP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem Medicaid |
$4,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Humana KY Medicaid |
$4,015.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,056.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,096.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$22,747.14
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$15,435.56 |
| Max. Negotiated Rate |
$22,747.14 |
| Rate for Payer: Anthem Medicaid |
$15,435.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,247.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,747.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,934.75
|
| Rate for Payer: Humana KY Medicaid |
$15,435.56
|
| Rate for Payer: Humana Medicare Advantage |
$16,247.96
|
| Rate for Payer: Kentucky WC Medicaid |
$15,589.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,497.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,744.27
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,508.70
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$7,809.48 |
| Max. Negotiated Rate |
$11,508.70 |
| Rate for Payer: Anthem Medicaid |
$7,809.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,220.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,508.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,097.68
|
| Rate for Payer: Humana KY Medicaid |
$7,809.48
|
| Rate for Payer: Humana Medicare Advantage |
$8,220.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,887.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,864.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,965.66
|
|
|
SPINAL FLUID-CELL COUNT/DIFF
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SPINAL FLUID-CELL COUNT/DIFF
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
|
IP
|
$77,586.03
|
|
|
Service Code
|
MSDRG 459
|
| Min. Negotiated Rate |
$52,647.66 |
| Max. Negotiated Rate |
$77,586.03 |
| Rate for Payer: Anthem Medicaid |
$52,647.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$55,418.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$77,586.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$74,815.10
|
| Rate for Payer: Humana KY Medicaid |
$52,647.66
|
| Rate for Payer: Humana Medicare Advantage |
$55,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$53,174.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66,502.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$53,700.61
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$42,790.86
|
|
|
Service Code
|
MSDRG 460
|
| Min. Negotiated Rate |
$29,036.66 |
| Max. Negotiated Rate |
$42,790.86 |
| Rate for Payer: Anthem Medicaid |
$29,036.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30,564.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$42,790.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$41,262.62
|
| Rate for Payer: Humana KY Medicaid |
$29,036.66
|
| Rate for Payer: Humana Medicare Advantage |
$30,564.90
|
| Rate for Payer: Kentucky WC Medicaid |
$29,327.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,677.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,617.39
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$71,070.09
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$48,226.13 |
| Max. Negotiated Rate |
$71,070.09 |
| Rate for Payer: Anthem Medicaid |
$48,226.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50,764.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71,070.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$68,531.87
|
| Rate for Payer: Humana KY Medicaid |
$48,226.13
|
| Rate for Payer: Humana Medicare Advantage |
$50,764.35
|
| Rate for Payer: Kentucky WC Medicaid |
$48,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$49,190.66
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$98,608.85
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$66,913.15 |
| Max. Negotiated Rate |
$98,608.85 |
| Rate for Payer: Anthem Medicaid |
$66,913.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70,434.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98,608.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$95,087.10
|
| Rate for Payer: Humana KY Medicaid |
$66,913.15
|
| Rate for Payer: Humana Medicare Advantage |
$70,434.89
|
| Rate for Payer: Kentucky WC Medicaid |
$67,582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84,521.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$68,251.41
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$53,004.56
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$35,967.38 |
| Max. Negotiated Rate |
$53,004.56 |
| Rate for Payer: Anthem Medicaid |
$35,967.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37,860.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53,004.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$51,111.54
|
| Rate for Payer: Humana KY Medicaid |
$35,967.38
|
| Rate for Payer: Humana Medicare Advantage |
$37,860.40
|
| Rate for Payer: Kentucky WC Medicaid |
$36,327.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45,432.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,686.73
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
|
IP
|
$40,103.80
|
|
|
Service Code
|
MSDRG 029
|
| Min. Negotiated Rate |
$27,213.29 |
| Max. Negotiated Rate |
$40,103.80 |
| Rate for Payer: Anthem Medicaid |
$27,213.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,645.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40,103.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,671.52
|
| Rate for Payer: Humana KY Medicaid |
$27,213.29
|
| Rate for Payer: Humana Medicare Advantage |
$28,645.57
|
| Rate for Payer: Kentucky WC Medicaid |
$27,485.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,374.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,757.56
|
|
