|
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 |
$300.00 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Ambetter Exchange |
$150.67
|
| 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 Individual/Medicaid |
$150.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$150.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.67
|
| 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 |
$195.87
|
| Rate for Payer: UHCCP Medicaid |
$134.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.67
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| 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 |
$2,533.91
|
| 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 |
$3,040.69
|
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
SPIDER FX 3MM
|
Facility
|
IP
|
$8,091.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,427.53 |
| Max. Negotiated Rate |
$7,768.08 |
| Rate for Payer: Aetna Commercial |
$6,230.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.56
|
| Rate for Payer: Cash Price |
$4,045.88
|
| Rate for Payer: Cigna Commercial |
$6,716.15
|
| Rate for Payer: First Health Commercial |
$7,687.16
|
| Rate for Payer: Humana Commercial |
$6,877.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,120.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,068.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,039.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.31
|
| Rate for Payer: PHCS Commercial |
$7,768.08
|
| Rate for Payer: United Healthcare All Payer |
$7,120.74
|
|
|
SPIDER FX 3MM
|
Facility
|
OP
|
$8,091.75
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,427.53 |
| Max. Negotiated Rate |
$7,768.08 |
| Rate for Payer: Aetna Commercial |
$6,230.65
|
| Rate for Payer: Anthem Medicaid |
$2,782.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.56
|
| Rate for Payer: Cash Price |
$4,045.88
|
| Rate for Payer: Cigna Commercial |
$6,716.15
|
| Rate for Payer: First Health Commercial |
$7,687.16
|
| Rate for Payer: Humana Commercial |
$6,877.99
|
| Rate for Payer: Humana KY Medicaid |
$2,782.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,120.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,068.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,039.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.31
|
| Rate for Payer: PHCS Commercial |
$7,768.08
|
| Rate for Payer: United Healthcare All Payer |
$7,120.74
|
|
|
SPIDER FX 4MM
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 4MM
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 5MM
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 5MM
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 6MM
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 6MM
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 7MM
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPIDER FX 7MM
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
SPINAL FLUID-CELL COUNT/DIFF
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
SPINAL FLUID-CELL COUNT/DIFF
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
SPINAL STIMULATOR INSERT/REPLA
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
76102308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.00 |
| 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 |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
SPINAL STIMULATOR INSERT/REPLA
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
76102308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$39,419.79 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,419.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,011.94
|
| 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 |
$28,156.99
|
| 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 |
$33,788.39
|
| 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 |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| 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 |
$322.01 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$640.98
|
| Rate for Payer: Ambetter Exchange |
$322.01
|
| Rate for Payer: Anthem Medicaid |
$418.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$322.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.01
|
| 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 |
$418.61
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.01
|
|
|
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 |
$322.01 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$640.98
|
| Rate for Payer: Ambetter Exchange |
$322.01
|
| Rate for Payer: Anthem Medicaid |
$418.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$322.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.01
|
| 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 |
$418.61
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.01
|
|
|
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 |
$466.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Ambetter Exchange |
$37.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.42
|
| Rate for Payer: Anthem Medicaid |
$62.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.41
|
| 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 |
$62.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.24
|
| Rate for Payer: Molina Healthcare Passport |
$62.00
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.11
|
| Rate for Payer: UHCCP Medicaid |
$21.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.01
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
51000045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.55 |
| 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 |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| 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 |
$272.75
|
| 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 |
$327.30
|
| 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 |
$622.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.82
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
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 |
$473.40 |
| Rate for Payer: Aetna Commercial |
$87.76
|
| Rate for Payer: Ambetter Exchange |
$77.07
|
| Rate for Payer: Anthem Medicaid |
$39.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$77.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.07
|
| 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 |
$100.19
|
| Rate for Payer: UHCCP Medicaid |
$276.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.07
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.34 |
| 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 |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
HCPCS 95990
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.70 |
| 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 |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
SPIN/BRAIN PUMP REFIL & MAIN
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 95991
|
| Hospital Charge Code |
51000045
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.40 |
| 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 |
$622.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.82
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
