|
CERVICAL SPINE 2-3V
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Anthem Medicaid |
$25.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$407.00
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$52.35
|
| Rate for Payer: Humana Medicaid |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.15
|
| Rate for Payer: Molina Healthcare Passport |
$25.64
|
| Rate for Payer: Multiplan PHCS |
$244.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$284.90
|
| Rate for Payer: UHCCP Medicaid |
$142.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
|
|
CERVICAL SPINE 2-3V
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem Medicaid |
$139.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Humana KY Medicaid |
$139.97
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$141.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.17
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
CERVICAL SPINE 2-3V
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.17
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
CERVICAL SPINE 2-3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320P0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Anthem Medicaid |
$25.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$52.35
|
| Rate for Payer: Humana Medicaid |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.15
|
| Rate for Payer: Molina Healthcare Passport |
$25.64
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
|
|
CERVICAL SPINE 2-3V(T
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320T0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem Medicaid |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Humana KY Medicaid |
$126.21
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
CERVICAL SPINE 2-3V(T
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320T0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.91 |
| Max. Negotiated Rate |
$582.72 |
| Rate for Payer: Aetna Commercial |
$467.39
|
| Rate for Payer: Anthem Medicaid |
$208.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$473.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cigna Commercial |
$503.81
|
| Rate for Payer: First Health Commercial |
$576.65
|
| Rate for Payer: Humana Commercial |
$515.95
|
| Rate for Payer: Humana KY Medicaid |
$208.75
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$210.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$497.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$534.16
|
| Rate for Payer: Ohio Health Group HMO |
$455.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.17
|
| Rate for Payer: PHCS Commercial |
$582.72
|
| Rate for Payer: United Healthcare All Payer |
$534.16
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.91 |
| Max. Negotiated Rate |
$582.72 |
| Rate for Payer: Aetna Commercial |
$467.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$473.46
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cigna Commercial |
$503.81
|
| Rate for Payer: First Health Commercial |
$576.65
|
| Rate for Payer: Humana Commercial |
$515.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$497.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$534.16
|
| Rate for Payer: Ohio Health Group HMO |
$455.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.17
|
| Rate for Payer: PHCS Commercial |
$582.72
|
| Rate for Payer: United Healthcare All Payer |
$534.16
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$607.00 |
| Rate for Payer: Aetna Commercial |
$79.08
|
| Rate for Payer: Anthem Medicaid |
$37.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.00
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: Healthspan PPO |
$74.10
|
| Rate for Payer: Humana Medicaid |
$37.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.34
|
| Rate for Payer: Molina Healthcare Passport |
$37.59
|
| Rate for Payer: Multiplan PHCS |
$364.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.90
|
| Rate for Payer: UHCCP Medicaid |
$212.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.97
|
|
|
CERVICAL SPINE ROUTINE 4-5V(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320P0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$79.08 |
| Rate for Payer: Aetna Commercial |
$79.08
|
| Rate for Payer: Anthem Medicaid |
$37.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: Healthspan PPO |
$74.10
|
| Rate for Payer: Humana Medicaid |
$37.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.34
|
| Rate for Payer: Molina Healthcare Passport |
$37.59
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.97
|
|
|
CERVICAL SPINE ROUTINE 4-5V(T
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320T0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
CERVICAL SPINE ROUTINE 4-5V(T
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320T0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem Medicaid |
$188.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Humana KY Medicaid |
$188.11
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$190.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$98.72
|
| Rate for Payer: Anthem Medicaid |
$46.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$93.46
|
| Rate for Payer: Healthspan PPO |
$92.50
|
| Rate for Payer: Humana Medicaid |
$46.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Molina Healthcare Passport |
$46.28
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.74
|
|
|
CERVICAL SPINE W/FLEX => 6V(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320P0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$98.72 |
| Rate for Payer: Aetna Commercial |
$98.72
|
| Rate for Payer: Anthem Medicaid |
$46.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$93.46
|
| Rate for Payer: Healthspan PPO |
$92.50
|
| Rate for Payer: Humana Medicaid |
$46.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Molina Healthcare Passport |
$46.28
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.74
|
|
|
CERVICAL SPINE W/FLEX => 6V(T
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320T0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
CERVICAL SPINE W/FLEX => 6V(T
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320T0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
CERVICOPLASTY
|
Professional
|
Both
|
$7,324.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
76100213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.26 |
| Max. Negotiated Rate |
$7,324.00 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Anthem Medicaid |
$496.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,324.00
|
| Rate for Payer: Cash Price |
$3,662.00
|
| Rate for Payer: Cash Price |
$3,662.00
|
| Rate for Payer: Cigna Commercial |
$1,000.90
|
| Rate for Payer: Healthspan PPO |
$841.87
|
| Rate for Payer: Humana Medicaid |
$496.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$506.19
|
| Rate for Payer: Molina Healthcare Passport |
$496.26
|
| Rate for Payer: Multiplan PHCS |
$4,394.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,126.80
|
| Rate for Payer: UHCCP Medicaid |
$2,563.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$501.22
|
|
|
CERVICOPLASTY
|
Facility
|
IP
|
$7,324.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
76100213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$952.12 |
| Max. Negotiated Rate |
$7,031.04 |
| Rate for Payer: Aetna Commercial |
$5,639.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,712.72
|
| Rate for Payer: Cash Price |
$3,662.00
|
| Rate for Payer: Cigna Commercial |
$6,078.92
|
| Rate for Payer: First Health Commercial |
$6,957.80
|
| Rate for Payer: Humana Commercial |
$6,225.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,005.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,405.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,445.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.44
|
| Rate for Payer: PHCS Commercial |
$7,031.04
|
| Rate for Payer: United Healthcare All Payer |
$6,445.12
|
|
|
CERVICOPLASTY
|
Facility
|
OP
|
$7,324.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
76100213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$952.12 |
| Max. Negotiated Rate |
$7,031.04 |
| Rate for Payer: Aetna Commercial |
$5,639.48
|
| Rate for Payer: Anthem Medicaid |
$2,518.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,712.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,662.00
|
| Rate for Payer: Cash Price |
$3,662.00
|
| Rate for Payer: Cigna Commercial |
$6,078.92
|
| Rate for Payer: First Health Commercial |
$6,957.80
|
| Rate for Payer: Humana Commercial |
$6,225.40
|
| Rate for Payer: Humana KY Medicaid |
$2,518.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,544.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,005.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,405.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,569.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,445.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.44
|
| Rate for Payer: PHCS Commercial |
$7,031.04
|
| Rate for Payer: United Healthcare All Payer |
$6,445.12
|
|
|
CERVICOPLASTY(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
761P0213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.26 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Anthem Medicaid |
$496.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$1,000.90
|
| Rate for Payer: Healthspan PPO |
$841.87
|
| Rate for Payer: Humana Medicaid |
$496.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$506.19
|
| Rate for Payer: Molina Healthcare Passport |
$496.26
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$501.22
|
|
|
CERVICOPLASTY(T
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
761T0213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
CERVICOPLASTY(T
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15819
|
| Hospital Charge Code |
761T0213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
CERVIDIL 10MG INSERT
|
Facility
|
OP
|
$693.98
|
|
|
Service Code
|
NDC 55566280001
|
| Hospital Charge Code |
25002935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$666.22 |
| Rate for Payer: Aetna Commercial |
$534.36
|
| Rate for Payer: Anthem Medicaid |
$238.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.30
|
| Rate for Payer: Cash Price |
$346.99
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: First Health Commercial |
$659.28
|
| Rate for Payer: Humana Commercial |
$589.88
|
| Rate for Payer: Humana KY Medicaid |
$238.66
|
| Rate for Payer: Kentucky WC Medicaid |
$241.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.70
|
| Rate for Payer: Ohio Health Group HMO |
$520.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.13
|
| Rate for Payer: PHCS Commercial |
$666.22
|
| Rate for Payer: United Healthcare All Payer |
$610.70
|
|
