|
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 |
$11.72 |
| 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 |
$31.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| 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 |
$11.72 |
| 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 |
$31.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| 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
|
$3,359.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.92 |
| Max. Negotiated Rate |
$3,225.36 |
| Rate for Payer: Aetna Commercial |
$2,587.01
|
| Rate for Payer: Anthem Medicaid |
$1,155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.61
|
| Rate for Payer: Cash Price |
$1,679.88
|
| Rate for Payer: Cigna Commercial |
$2,788.59
|
| Rate for Payer: First Health Commercial |
$3,191.76
|
| Rate for Payer: Humana Commercial |
$2,855.79
|
| Rate for Payer: Humana KY Medicaid |
$1,155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,167.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,754.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,922.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.23
|
| Rate for Payer: PHCS Commercial |
$3,225.36
|
| Rate for Payer: United Healthcare All Payer |
$2,956.58
|
|
|
K-WIRE PERI-LOC 2.0 MM
|
Facility
|
IP
|
$3,359.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.92 |
| Max. Negotiated Rate |
$3,225.36 |
| Rate for Payer: Aetna Commercial |
$2,587.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.61
|
| Rate for Payer: Cash Price |
$1,679.88
|
| Rate for Payer: Cigna Commercial |
$2,788.59
|
| Rate for Payer: First Health Commercial |
$3,191.76
|
| Rate for Payer: Humana Commercial |
$2,855.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,754.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,922.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.23
|
| Rate for Payer: PHCS Commercial |
$3,225.36
|
| Rate for Payer: United Healthcare All Payer |
$2,956.58
|
|
|
KWIRE T2 3*285MM STERILE
|
Facility
|
OP
|
$1,683.80
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.14 |
| Max. Negotiated Rate |
$1,616.45 |
| Rate for Payer: Aetna Commercial |
$1,296.53
|
| Rate for Payer: Anthem Medicaid |
$579.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.36
|
| Rate for Payer: Cash Price |
$841.90
|
| Rate for Payer: Cigna Commercial |
$1,397.55
|
| Rate for Payer: First Health Commercial |
$1,599.61
|
| Rate for Payer: Humana Commercial |
$1,431.23
|
| Rate for Payer: Humana KY Medicaid |
$579.06
|
| Rate for Payer: Kentucky WC Medicaid |
$584.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.82
|
| Rate for Payer: PHCS Commercial |
$1,616.45
|
| Rate for Payer: United Healthcare All Payer |
$1,481.74
|
|
|
KWIRE T2 3*285MM STERILE
|
Facility
|
IP
|
$1,683.80
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.14 |
| Max. Negotiated Rate |
$1,616.45 |
| Rate for Payer: Aetna Commercial |
$1,296.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.36
|
| Rate for Payer: Cash Price |
$841.90
|
| Rate for Payer: Cigna Commercial |
$1,397.55
|
| Rate for Payer: First Health Commercial |
$1,599.61
|
| Rate for Payer: Humana Commercial |
$1,431.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.82
|
| Rate for Payer: PHCS Commercial |
$1,616.45
|
| Rate for Payer: United Healthcare All Payer |
$1,481.74
|
|
|
KYBELLA INJECTIONS COSMETIC
|
Professional
|
Both
|
$1,200.00
|
|
| Hospital Charge Code |
22200021
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$840.00 |
| 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
|
|
|
KYLEENA IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636T0069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYLEENA IUD
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,366.87
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,433.29
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
|
|
KYLEENA IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
25002481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYLEENA IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYLEENA IUD
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYLEENA IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636T0069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYLEENA IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
25002481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
KYPHOPLAS EA ADD'L VERT BODY(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 22515
|
| Hospital Charge Code |
761P0426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.11 |
| Max. Negotiated Rate |
$3,335.95 |
| Rate for Payer: Ambetter Exchange |
$205.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.11
|
| Rate for Payer: Anthem Medicaid |
$3,270.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.74
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: Humana Medicaid |
$3,270.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,335.95
|
| Rate for Payer: Molina Healthcare Passport |
$3,270.54
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.31
|
| Rate for Payer: UHCCP Medicaid |
$177.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,303.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.62
|
|
|
KYPHOPLASTY EA ADD'L VERT BODY
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 22515
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| 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 |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
KYPHOPLASTY EA ADD'L VERT BODY
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 22515
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.11 |
| Max. Negotiated Rate |
$3,335.95 |
| Rate for Payer: Ambetter Exchange |
$205.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.11
|
| Rate for Payer: Anthem Medicaid |
$3,270.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.74
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: Humana Medicaid |
$3,270.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,335.95
|
| Rate for Payer: Molina Healthcare Passport |
$3,270.54
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.31
|
| Rate for Payer: UHCCP Medicaid |
$177.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,303.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.62
|
|
|
KYPHOPLASTY EA ADD'L VERT BODY
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 22515
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| 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: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Kentucky WC Medicaid |
$165.01
|
| 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: 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 |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
KYPHOPLASTY LUMBAR
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 22514
|
| Hospital Charge Code |
76100425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.84 |
| Max. Negotiated Rate |
$5,504.20 |
| Rate for Payer: Ambetter Exchange |
$448.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$376.84
|
| Rate for Payer: Anthem Medicaid |
$5,396.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.46
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$952.26
|
| Rate for Payer: Humana Medicaid |
$5,396.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$661.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,504.20
|
| Rate for Payer: Molina Healthcare Passport |
$5,396.27
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.34
|
| Rate for Payer: UHCCP Medicaid |
$395.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,450.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.72
|
|
|
KYPHOPLASTY LUMBAR
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 22514
|
| Hospital Charge Code |
76100425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.06 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem Medicaid |
$349.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Humana KY Medicaid |
$349.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$352.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$356.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.35
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
|
KYPHOPLASTY LUMBAR
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 22514
|
| Hospital Charge Code |
76100425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$974.40 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.35
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
|
KYPHOPLASTY LUMBAR (P
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 22514
|
| Hospital Charge Code |
761P0425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.84 |
| Max. Negotiated Rate |
$5,504.20 |
| Rate for Payer: Ambetter Exchange |
$448.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$376.84
|
| Rate for Payer: Anthem Medicaid |
$5,396.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.46
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$952.26
|
| Rate for Payer: Humana Medicaid |
$5,396.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$661.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,504.20
|
| Rate for Payer: Molina Healthcare Passport |
$5,396.27
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.34
|
| Rate for Payer: UHCCP Medicaid |
$395.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,450.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.72
|
|
|
KYPHOPLASTY THORACIC
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 22513
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
KYPHOPLASTY THORACIC
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 22513
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
KYPHOPLASTY THORACIC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 22513
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.43 |
| Max. Negotiated Rate |
$5,535.46 |
| Rate for Payer: Ambetter Exchange |
$480.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$403.43
|
| Rate for Payer: Anthem Medicaid |
$5,426.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$480.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$576.62
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,022.33
|
| Rate for Payer: Humana Medicaid |
$5,426.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$710.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$480.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,535.46
|
| Rate for Payer: Molina Healthcare Passport |
$5,426.92
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$624.68
|
| Rate for Payer: UHCCP Medicaid |
$423.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,481.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$480.52
|
|
