|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$70,494.54
|
|
|
Service Code
|
MSDRG 028
|
| Min. Negotiated Rate |
$47,835.58 |
| Max. Negotiated Rate |
$70,494.54 |
| Rate for Payer: Anthem Medicaid |
$47,835.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50,353.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$70,494.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$67,976.87
|
| Rate for Payer: Humana KY Medicaid |
$47,835.58
|
| Rate for Payer: Humana Medicare Advantage |
$50,353.24
|
| Rate for Payer: Kentucky WC Medicaid |
$48,313.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60,423.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$48,792.29
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,128.12
|
|
|
Service Code
|
MSDRG 030
|
| Min. Negotiated Rate |
$18,408.37 |
| Max. Negotiated Rate |
$27,128.12 |
| Rate for Payer: Anthem Medicaid |
$18,408.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,377.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27,128.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$26,159.26
|
| Rate for Payer: Humana KY Medicaid |
$18,408.37
|
| Rate for Payer: Humana Medicare Advantage |
$19,377.23
|
| Rate for Payer: Kentucky WC Medicaid |
$18,592.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,252.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,776.54
|
|
|
SPINAL STIMULATOR INSERT/REPLA
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
76102308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
SPINAL STIMULATOR INSERT/REPLA
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
76102308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.53 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$640.98
|
| Rate for Payer: Anthem Medicaid |
$418.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: Healthspan PPO |
$500.46
|
| Rate for Payer: Humana Medicaid |
$418.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.90
|
| Rate for Payer: Molina Healthcare Passport |
$418.53
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.72
|
|
|
SPINAL STIMULATOR INSERT/REPLA
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
76102308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$37,593.53 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26,852.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,593.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,250.90
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$26,852.52
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,223.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
SPINAL STIMULATOR INSERT/REP(P
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
761P2308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.53 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$640.98
|
| Rate for Payer: Anthem Medicaid |
$418.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: Healthspan PPO |
$500.46
|
| Rate for Payer: Humana Medicaid |
$418.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.90
|
| Rate for Payer: Molina Healthcare Passport |
$418.53
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.72
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
51000045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.42
|
| Rate for Payer: Anthem Medicaid |
$28.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$131.86
|
| Rate for Payer: Healthspan PPO |
$116.93
|
| Rate for Payer: Humana Medicaid |
$28.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.17
|
| Rate for Payer: Molina Healthcare Passport |
$28.60
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$544.60
|
| Rate for Payer: UHCCP Medicaid |
$21.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.89
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem Medicaid |
$271.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Humana KY Medicaid |
$271.34
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$274.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna Commercial |
$87.76
|
| Rate for Payer: Anthem Medicaid |
$39.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$789.00
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$90.07
|
| Rate for Payer: Healthspan PPO |
$77.30
|
| Rate for Payer: Humana Medicaid |
$39.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.38
|
| Rate for Payer: Molina Healthcare Passport |
$39.59
|
| Rate for Payer: Multiplan PHCS |
$473.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$552.30
|
| Rate for Payer: UHCCP Medicaid |
$276.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.99
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
51000045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem Medicaid |
$267.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Humana KY Medicaid |
$267.55
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$270.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
51000045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
510P0044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$87.76
|
| Rate for Payer: Anthem Medicaid |
$39.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$90.07
|
| Rate for Payer: Healthspan PPO |
$77.30
|
| Rate for Payer: Humana Medicaid |
$39.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.38
|
| Rate for Payer: Molina Healthcare Passport |
$39.59
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.99
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
510P0045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.42
|
| Rate for Payer: Anthem Medicaid |
$28.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$131.86
|
| Rate for Payer: Healthspan PPO |
$116.93
|
| Rate for Payer: Humana Medicaid |
$28.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.17
|
| Rate for Payer: Molina Healthcare Passport |
$28.60
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$21.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.89
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(T
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
510T0044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$613.44 |
| Rate for Payer: Aetna Commercial |
$492.03
|
| Rate for Payer: Anthem Medicaid |
$219.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$498.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$530.37
|
| Rate for Payer: First Health Commercial |
$607.05
|
| Rate for Payer: Humana Commercial |
$543.15
|
| Rate for Payer: Humana KY Medicaid |
$219.75
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$221.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$471.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$562.32
|
| Rate for Payer: Ohio Health Group HMO |
$479.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.09
|
| Rate for Payer: PHCS Commercial |
$613.44
|
| Rate for Payer: United Healthcare All Payer |
$562.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(T
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
510T0044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$613.44 |
| Rate for Payer: Aetna Commercial |
$492.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$498.42
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$530.37
|
| Rate for Payer: First Health Commercial |
$607.05
|
| Rate for Payer: Humana Commercial |
$543.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$471.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$562.32
|
| Rate for Payer: Ohio Health Group HMO |
$479.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.09
|
| Rate for Payer: PHCS Commercial |
$613.44
|
| Rate for Payer: United Healthcare All Payer |
$562.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(T
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
510T0045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.39 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$464.31
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$470.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$500.49
|
| Rate for Payer: First Health Commercial |
$572.85
|
| Rate for Payer: Humana Commercial |
$512.55
|
| Rate for Payer: Humana KY Medicaid |
$207.37
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$209.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$494.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$530.64
|
| Rate for Payer: Ohio Health Group HMO |
$452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.93
|
| Rate for Payer: PHCS Commercial |
$578.88
|
| Rate for Payer: United Healthcare All Payer |
$530.64
|
|
|
SPIN/BRAIN PUMP REFIL & MAI(T
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
510T0045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.39 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$464.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$470.34
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$500.49
|
| Rate for Payer: First Health Commercial |
$572.85
|
| Rate for Payer: Humana Commercial |
$512.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$494.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$530.64
|
| Rate for Payer: Ohio Health Group HMO |
$452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.93
|
| Rate for Payer: PHCS Commercial |
$578.88
|
| Rate for Payer: United Healthcare All Payer |
$530.64
|
|
|
SPINE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
76101089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$889.21 |
| Rate for Payer: Aetna Commercial |
$841.65
|
| Rate for Payer: Anthem Medicaid |
$412.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$889.21
|
| Rate for Payer: Healthspan PPO |
$762.35
|
| Rate for Payer: Humana Medicaid |
$412.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.76
|
| Rate for Payer: Molina Healthcare Passport |
$412.51
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.64
|
|
|
SPINE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
76101089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPINE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
76101089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPINE ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
761P1089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$889.21 |
| Rate for Payer: Aetna Commercial |
$841.65
|
| Rate for Payer: Anthem Medicaid |
$412.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$889.21
|
| Rate for Payer: Healthspan PPO |
$762.35
|
| Rate for Payer: Humana Medicaid |
$412.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.76
|
| Rate for Payer: Molina Healthcare Passport |
$412.51
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.64
|
|
|
SPIRIVA 18MCG HH CAP
|
Facility
|
IP
|
$519.41
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
25001421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.63 |
| Rate for Payer: Aetna Commercial |
$399.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.14
|
| Rate for Payer: Cash Price |
$259.70
|
| Rate for Payer: Cigna Commercial |
$431.11
|
| Rate for Payer: First Health Commercial |
$493.44
|
| Rate for Payer: Humana Commercial |
$441.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.08
|
| Rate for Payer: Ohio Health Group HMO |
$389.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.02
|
| Rate for Payer: PHCS Commercial |
$498.63
|
| Rate for Payer: United Healthcare All Payer |
$457.08
|
|
|
SPIRIVA 18MCG HH CAP
|
Facility
|
OP
|
$519.41
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
25001421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.63 |
| Rate for Payer: Aetna Commercial |
$399.95
|
| Rate for Payer: Anthem Medicaid |
$178.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.14
|
| Rate for Payer: Cash Price |
$259.70
|
| Rate for Payer: Cigna Commercial |
$431.11
|
| Rate for Payer: First Health Commercial |
$493.44
|
| Rate for Payer: Humana Commercial |
$441.50
|
| Rate for Payer: Humana KY Medicaid |
$178.63
|
| Rate for Payer: Kentucky WC Medicaid |
$180.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.08
|
| Rate for Payer: Ohio Health Group HMO |
$389.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.02
|
| Rate for Payer: PHCS Commercial |
$498.63
|
| Rate for Payer: United Healthcare All Payer |
$457.08
|
|
|
SPIROFLEX ULTRA
|
Facility
|
IP
|
$9,114.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.88 |
| Max. Negotiated Rate |
$8,749.92 |
| Rate for Payer: Aetna Commercial |
$7,018.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,109.31
|
| Rate for Payer: Cash Price |
$4,557.25
|
| Rate for Payer: Cigna Commercial |
$7,565.04
|
| Rate for Payer: First Health Commercial |
$8,658.78
|
| Rate for Payer: Humana Commercial |
$7,747.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,726.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,822.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,184.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,825.50
|
| Rate for Payer: PHCS Commercial |
$8,749.92
|
| Rate for Payer: United Healthcare All Payer |
$8,020.76
|
|
