|
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 |
$131.86 |
| 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 |
$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 |
$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 |
$105.00
|
| 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 & 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 |
$100.19 |
| 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 |
$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: 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 |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.19
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.07
|
|
|
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 |
$219.75 |
| 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 |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$498.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.91
|
| 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 |
$207.37 |
| 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 |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$470.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| 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 |
$272.75
|
| 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 |
$327.30
|
| 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 |
$482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.07
|
| 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 |
$180.90 |
| 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 |
$482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.07
|
| Rate for Payer: PHCS Commercial |
$578.88
|
| Rate for Payer: United Healthcare All Payer |
$530.64
|
|
|
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 |
$191.70 |
| 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 |
$511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.91
|
| Rate for Payer: PHCS Commercial |
$613.44
|
| Rate for Payer: United Healthcare All Payer |
$562.32
|
|
|
SPINE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
76101089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPINE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 29850
|
| Hospital Charge Code |
76101089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| 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 |
$1,774.50
|
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
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: Ambetter Exchange |
$596.89
|
| Rate for Payer: Anthem Medicaid |
$549.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$596.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$596.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$716.27
|
| 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 |
$549.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$596.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.15
|
| Rate for Payer: Molina Healthcare Passport |
$549.17
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$775.96
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$596.89
|
|
|
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: Ambetter Exchange |
$596.89
|
| Rate for Payer: Anthem Medicaid |
$549.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$596.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$596.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$716.27
|
| 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 |
$549.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$596.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.15
|
| Rate for Payer: Molina Healthcare Passport |
$549.17
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$775.96
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$596.89
|
|
|
SPIRIVA 18MCG HH CAP
|
Facility
|
OP
|
$295.85
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
25001421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna Commercial |
$227.80
|
| Rate for Payer: Anthem Medicaid |
$101.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.76
|
| Rate for Payer: Cash Price |
$147.93
|
| Rate for Payer: Cigna Commercial |
$245.56
|
| Rate for Payer: First Health Commercial |
$281.06
|
| Rate for Payer: Humana Commercial |
$251.47
|
| Rate for Payer: Humana KY Medicaid |
$101.74
|
| Rate for Payer: Kentucky WC Medicaid |
$102.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.35
|
| Rate for Payer: Ohio Health Group HMO |
$221.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.14
|
| Rate for Payer: PHCS Commercial |
$284.02
|
| Rate for Payer: United Healthcare All Payer |
$260.35
|
|
|
SPIRIVA 18MCG HH CAP
|
Facility
|
IP
|
$295.85
|
|
|
Service Code
|
NDC 597007575
|
| Hospital Charge Code |
25001421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna Commercial |
$227.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.76
|
| Rate for Payer: Cash Price |
$147.93
|
| Rate for Payer: Cigna Commercial |
$245.56
|
| Rate for Payer: First Health Commercial |
$281.06
|
| Rate for Payer: Humana Commercial |
$251.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.35
|
| Rate for Payer: Ohio Health Group HMO |
$221.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.14
|
| Rate for Payer: PHCS Commercial |
$284.02
|
| Rate for Payer: United Healthcare All Payer |
$260.35
|
|
|
SPIROFLEX ULTRA
|
Facility
|
OP
|
$9,314.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,794.35 |
| Max. Negotiated Rate |
$8,941.92 |
| Rate for Payer: Aetna Commercial |
$7,172.16
|
| Rate for Payer: Anthem Medicaid |
$3,203.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.31
|
| Rate for Payer: Cash Price |
$4,657.25
|
| Rate for Payer: Cigna Commercial |
$7,731.03
|
| Rate for Payer: First Health Commercial |
$8,848.77
|
| Rate for Payer: Humana Commercial |
$7,917.32
|
| Rate for Payer: Humana KY Medicaid |
$3,203.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,235.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,637.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,196.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,985.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,451.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,103.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.01
|
| Rate for Payer: PHCS Commercial |
$8,941.92
|
| Rate for Payer: United Healthcare All Payer |
$8,196.76
|
|
|
SPIROFLEX ULTRA
|
Facility
|
IP
|
$9,314.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,794.35 |
| Max. Negotiated Rate |
$8,941.92 |
| Rate for Payer: Aetna Commercial |
$7,172.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.31
|
| Rate for Payer: Cash Price |
$4,657.25
|
| Rate for Payer: Cigna Commercial |
$7,731.03
|
| Rate for Payer: First Health Commercial |
$8,848.77
|
| Rate for Payer: Humana Commercial |
$7,917.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,637.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,196.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,985.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,451.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,103.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.01
|
| Rate for Payer: PHCS Commercial |
$8,941.92
|
| Rate for Payer: United Healthcare All Payer |
$8,196.76
|
|
|
SPIROMETRY PRE/POST
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$210.12 |
| Max. Negotiated Rate |
$586.56 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Anthem Medicaid |
$210.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$507.13
|
| Rate for Payer: First Health Commercial |
$580.45
|
| Rate for Payer: Humana Commercial |
$519.35
|
| Rate for Payer: Humana KY Medicaid |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$212.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.68
|
| Rate for Payer: Ohio Health Group HMO |
$458.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.59
|
| Rate for Payer: PHCS Commercial |
$586.56
|
| Rate for Payer: United Healthcare All Payer |
$537.68
|
|
|
SPIROMETRY PRE/POST
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$366.60 |
| Rate for Payer: Aetna Commercial |
$88.17
|
| Rate for Payer: Ambetter Exchange |
$35.19
|
| Rate for Payer: Anthem Medicaid |
$45.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.23
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$82.82
|
| Rate for Payer: Healthspan PPO |
$68.30
|
| Rate for Payer: Humana Medicaid |
$45.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.26
|
| Rate for Payer: Molina Healthcare Passport |
$45.35
|
| Rate for Payer: Multiplan PHCS |
$366.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.75
|
| Rate for Payer: UHCCP Medicaid |
$213.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.19
|
|
|
SPIROMETRY PRE/POST
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$586.56 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.58
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$507.13
|
| Rate for Payer: First Health Commercial |
$580.45
|
| Rate for Payer: Humana Commercial |
$519.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.68
|
| Rate for Payer: Ohio Health Group HMO |
$458.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.59
|
| Rate for Payer: PHCS Commercial |
$586.56
|
| Rate for Payer: United Healthcare All Payer |
$537.68
|
|
|
SPIROMETRY PRE/POST(P
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
460P0002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$88.17 |
| Rate for Payer: Aetna Commercial |
$88.17
|
| Rate for Payer: Ambetter Exchange |
$35.19
|
| Rate for Payer: Anthem Medicaid |
$45.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.23
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$82.82
|
| Rate for Payer: Healthspan PPO |
$68.30
|
| Rate for Payer: Humana Medicaid |
$45.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.26
|
| Rate for Payer: Molina Healthcare Passport |
$45.35
|
| Rate for Payer: Multiplan PHCS |
$31.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.75
|
| Rate for Payer: UHCCP Medicaid |
$18.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.19
|
|
|
SPIROMETRY PRE/POST(T
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
460T0002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$191.90 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem Medicaid |
$191.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Humana KY Medicaid |
$191.90
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$193.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
SPIROMETRY PRE/POST(T
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
460T0002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
SPIRONOLACTONE 100MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 59746021801
|
| Hospital Charge Code |
25003481
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
SPIRONOLACTONE 100MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 59746021801
|
| Hospital Charge Code |
25003481
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
SP KNOX BILAT CATARACT SX (P)
|
Professional
|
Both
|
$6,700.00
|
|
| Hospital Charge Code |
36001279
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$2,345.00 |
| Max. Negotiated Rate |
$4,690.00 |
| Rate for Payer: Cash Price |
$3,350.00
|
| Rate for Payer: Multiplan PHCS |
$4,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,690.00
|
| Rate for Payer: UHCCP Medicaid |
$2,345.00
|
|
|
SP KNOX BILAT CATARACT SX (P)
|
Facility
|
OP
|
$6,700.00
|
|
| Hospital Charge Code |
36001279
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$2,010.00 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$5,159.00
|
| Rate for Payer: Anthem Medicaid |
$2,304.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,226.00
|
| Rate for Payer: Cash Price |
$3,350.00
|
| Rate for Payer: Cigna Commercial |
$5,561.00
|
| Rate for Payer: First Health Commercial |
$6,365.00
|
| Rate for Payer: Humana Commercial |
$5,695.00
|
| Rate for Payer: Humana KY Medicaid |
$2,304.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,327.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,494.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,944.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,829.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.00
|
| Rate for Payer: PHCS Commercial |
$6,432.00
|
| Rate for Payer: United Healthcare All Payer |
$5,896.00
|
|
|
SP KNOX BILAT CATARACT SX (P)
|
Facility
|
IP
|
$6,700.00
|
|
| Hospital Charge Code |
36001279
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$2,010.00 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$5,159.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,226.00
|
| Rate for Payer: Cash Price |
$3,350.00
|
| Rate for Payer: Cigna Commercial |
$5,561.00
|
| Rate for Payer: First Health Commercial |
$6,365.00
|
| Rate for Payer: Humana Commercial |
$5,695.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,494.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,944.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,829.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.00
|
| Rate for Payer: PHCS Commercial |
$6,432.00
|
| Rate for Payer: United Healthcare All Payer |
$5,896.00
|
|
