|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$38,533.89
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$26,148.00 |
| Max. Negotiated Rate |
$38,533.89 |
| Rate for Payer: Anthem Medicaid |
$26,148.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27,524.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38,533.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$37,157.68
|
| Rate for Payer: Humana KY Medicaid |
$26,148.00
|
| Rate for Payer: Humana Medicare Advantage |
$27,524.21
|
| Rate for Payer: Kentucky WC Medicaid |
$26,409.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,029.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,670.96
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,072.54
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$12,263.51 |
| Max. Negotiated Rate |
$18,072.54 |
| Rate for Payer: Anthem Medicaid |
$12,263.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,908.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,072.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,427.10
|
| Rate for Payer: Humana KY Medicaid |
$12,263.51
|
| Rate for Payer: Humana Medicare Advantage |
$12,908.96
|
| Rate for Payer: Kentucky WC Medicaid |
$12,386.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,490.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,508.78
|
|
|
KNOT PUSH-SUT CUT ULT FAST FIX
|
Facility
|
OP
|
$1,805.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$1,733.64 |
| Rate for Payer: Aetna Commercial |
$1,390.53
|
| Rate for Payer: Anthem Medicaid |
$621.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.59
|
| Rate for Payer: Cash Price |
$902.94
|
| Rate for Payer: Cigna Commercial |
$1,498.88
|
| Rate for Payer: First Health Commercial |
$1,715.59
|
| Rate for Payer: Humana Commercial |
$1,535.00
|
| Rate for Payer: Humana KY Medicaid |
$621.04
|
| Rate for Payer: Kentucky WC Medicaid |
$627.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.82
|
| Rate for Payer: PHCS Commercial |
$1,733.64
|
| Rate for Payer: United Healthcare All Payer |
$1,589.17
|
|
|
KNOT PUSH-SUT CUT ULT FAST FIX
|
Facility
|
IP
|
$1,805.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$1,733.64 |
| Rate for Payer: Aetna Commercial |
$1,390.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.59
|
| Rate for Payer: Cash Price |
$902.94
|
| Rate for Payer: Cigna Commercial |
$1,498.88
|
| Rate for Payer: First Health Commercial |
$1,715.59
|
| Rate for Payer: Humana Commercial |
$1,535.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.82
|
| Rate for Payer: PHCS Commercial |
$1,733.64
|
| Rate for Payer: United Healthcare All Payer |
$1,589.17
|
|
|
KOH PREP SKIN/HAIR/NAIL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
30001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.47
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
KOH PREP SKIN/HAIR/NAIL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
30001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.47
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
K-PHOS NEUTRAL TAB (COMBI 1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
25000825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
K-PHOS NEUTRAL TAB (COMBI 1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
25000825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
KPHOS(POT PHOSPHATE) 500MG TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
25000826
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
KPHOS(POT PHOSPHATE) 500MG TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
25000826
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
|
|
K-WIRE 1.1*150MM BLUNT/TROCAR
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
K-WIRE 1.1*150MM BLUNT/TROCAR
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
KWIRE 1.35MM
|
Facility
|
IP
|
$793.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.97 |
| Rate for Payer: Aetna Commercial |
$611.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.10
|
| Rate for Payer: Cash Price |
$396.86
|
| Rate for Payer: Cigna Commercial |
$658.79
|
| Rate for Payer: First Health Commercial |
$754.03
|
| Rate for Payer: Humana Commercial |
$674.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.47
|
| Rate for Payer: Ohio Health Group HMO |
$595.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.05
|
| Rate for Payer: PHCS Commercial |
$761.97
|
| Rate for Payer: United Healthcare All Payer |
$698.47
|
|
|
KWIRE 1.35MM
|
Facility
|
OP
|
$793.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.97 |
| Rate for Payer: Aetna Commercial |
$611.16
|
| Rate for Payer: Anthem Medicaid |
$272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.10
|
| Rate for Payer: Cash Price |
$396.86
|
| Rate for Payer: Cigna Commercial |
$658.79
|
| Rate for Payer: First Health Commercial |
$754.03
|
| Rate for Payer: Humana Commercial |
$674.66
|
| Rate for Payer: Humana KY Medicaid |
$272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$275.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.47
|
| Rate for Payer: Ohio Health Group HMO |
$595.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.05
|
| Rate for Payer: PHCS Commercial |
$761.97
|
| Rate for Payer: United Healthcare All Payer |
$698.47
|
|
|
K-WIRE 2.3*150
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
K-WIRE 2.3*150
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
KWIRE ASNIS MICRO 1.2*100MM
|
Facility
|
IP
|
$528.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$507.77 |
| Rate for Payer: Aetna Commercial |
$407.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.57
|
| Rate for Payer: Cash Price |
$264.46
|
| Rate for Payer: Cigna Commercial |
$439.01
|
| Rate for Payer: First Health Commercial |
$502.48
|
| Rate for Payer: Humana Commercial |
$449.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$390.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$465.46
|
| Rate for Payer: Ohio Health Group HMO |
$396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.97
|
| Rate for Payer: PHCS Commercial |
$507.77
|
| Rate for Payer: United Healthcare All Payer |
$465.46
|
|
|
KWIRE ASNIS MICRO 1.2*100MM
|
Facility
|
OP
|
$528.93
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$507.77 |
| Rate for Payer: Aetna Commercial |
$407.28
|
| Rate for Payer: Anthem Medicaid |
$181.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.57
|
| Rate for Payer: Cash Price |
$264.46
|
| Rate for Payer: Cigna Commercial |
$439.01
|
| Rate for Payer: First Health Commercial |
$502.48
|
| Rate for Payer: Humana Commercial |
$449.59
|
| Rate for Payer: Humana KY Medicaid |
$181.90
|
| Rate for Payer: Kentucky WC Medicaid |
$183.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$390.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$465.46
|
| Rate for Payer: Ohio Health Group HMO |
$396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.97
|
| Rate for Payer: PHCS Commercial |
$507.77
|
| Rate for Payer: United Healthcare All Payer |
$465.46
|
|
|
K-WIRE D DIAMOND 9*.062 1.6
|
Facility
|
OP
|
$39.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$37.52 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: Anthem Medicaid |
$13.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.48
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cigna Commercial |
$32.44
|
| Rate for Payer: First Health Commercial |
$37.13
|
| Rate for Payer: Humana Commercial |
$33.22
|
| Rate for Payer: Humana KY Medicaid |
$13.44
|
| Rate for Payer: Kentucky WC Medicaid |
$13.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.39
|
| Rate for Payer: Ohio Health Group HMO |
$29.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.11
|
| Rate for Payer: PHCS Commercial |
$37.52
|
| Rate for Payer: United Healthcare All Payer |
$34.39
|
|
|
K-WIRE D DIAMOND 9*.062 1.6
|
Facility
|
IP
|
$39.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$37.52 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.48
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cigna Commercial |
$32.44
|
| Rate for Payer: First Health Commercial |
$37.13
|
| Rate for Payer: Humana Commercial |
$33.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.39
|
| Rate for Payer: Ohio Health Group HMO |
$29.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.11
|
| Rate for Payer: PHCS Commercial |
$37.52
|
| Rate for Payer: United Healthcare All Payer |
$34.39
|
|
|
K-WIRE PERI-LOC 2.0 MM
|
Facility
|
OP
|
$3,469.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.98 |
| Max. Negotiated Rate |
$3,330.34 |
| Rate for Payer: Aetna Commercial |
$2,671.21
|
| Rate for Payer: Anthem Medicaid |
$1,193.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.90
|
| Rate for Payer: Cash Price |
$1,734.55
|
| Rate for Payer: Cigna Commercial |
$2,879.35
|
| Rate for Payer: First Health Commercial |
$3,295.64
|
| Rate for Payer: Humana Commercial |
$2,948.74
|
| Rate for Payer: Humana KY Medicaid |
$1,193.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.42
|
| Rate for Payer: PHCS Commercial |
$3,330.34
|
| Rate for Payer: United Healthcare All Payer |
$3,052.81
|
|
|
K-WIRE PERI-LOC 2.0 MM
|
Facility
|
IP
|
$3,469.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.98 |
| Max. Negotiated Rate |
$3,330.34 |
| Rate for Payer: Aetna Commercial |
$2,671.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.90
|
| Rate for Payer: Cash Price |
$1,734.55
|
| Rate for Payer: Cigna Commercial |
$2,879.35
|
| Rate for Payer: First Health Commercial |
$3,295.64
|
| Rate for Payer: Humana Commercial |
$2,948.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.42
|
| Rate for Payer: PHCS Commercial |
$3,330.34
|
| Rate for Payer: United Healthcare All Payer |
$3,052.81
|
|
|
KWIRE T2 3*285MM STERILE
|
Facility
|
OP
|
$1,565.73
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.10 |
| Rate for Payer: Aetna Commercial |
$1,205.61
|
| Rate for Payer: Anthem Medicaid |
$538.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.27
|
| Rate for Payer: Cash Price |
$782.87
|
| Rate for Payer: Cigna Commercial |
$1,299.56
|
| Rate for Payer: First Health Commercial |
$1,487.44
|
| Rate for Payer: Humana Commercial |
$1,330.87
|
| Rate for Payer: Humana KY Medicaid |
$538.45
|
| Rate for Payer: Kentucky WC Medicaid |
$543.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.38
|
| Rate for Payer: PHCS Commercial |
$1,503.10
|
| Rate for Payer: United Healthcare All Payer |
$1,377.84
|
|
|
KWIRE T2 3*285MM STERILE
|
Facility
|
IP
|
$1,565.73
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.10 |
| Rate for Payer: Aetna Commercial |
$1,205.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.27
|
| Rate for Payer: Cash Price |
$782.87
|
| Rate for Payer: Cigna Commercial |
$1,299.56
|
| Rate for Payer: First Health Commercial |
$1,487.44
|
| Rate for Payer: Humana Commercial |
$1,330.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.38
|
| Rate for Payer: PHCS Commercial |
$1,503.10
|
| Rate for Payer: United Healthcare All Payer |
$1,377.84
|
|
|
KYBELLA INJECTIONS COSMETIC
|
Professional
|
Both
|
$1,200.00
|
|
| Hospital Charge Code |
22200021
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
