|
DRESSING CHANGE /NOT BURN
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
76100227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$1,048.32 |
| Rate for Payer: Aetna Commercial |
$840.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.76
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$906.36
|
| Rate for Payer: First Health Commercial |
$1,037.40
|
| Rate for Payer: Humana Commercial |
$928.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.96
|
| Rate for Payer: Ohio Health Group HMO |
$819.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.52
|
| Rate for Payer: PHCS Commercial |
$1,048.32
|
| Rate for Payer: United Healthcare All Payer |
$960.96
|
|
|
DRESSING CHANGE /NOT BURN
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
76100227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$71.57
|
| Rate for Payer: Anthem Medicaid |
$32.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,092.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$67.65
|
| Rate for Payer: Healthspan PPO |
$57.23
|
| Rate for Payer: Humana Medicaid |
$32.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Passport |
$32.84
|
| Rate for Payer: Multiplan PHCS |
$655.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$764.40
|
| Rate for Payer: UHCCP Medicaid |
$382.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.17
|
|
|
DRESSING CHANGE /NOT BURN
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DRESSING CHANGE /NOT BURN
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
76100227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$1,048.32 |
| Rate for Payer: Aetna Commercial |
$840.84
|
| Rate for Payer: Anthem Medicaid |
$375.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$906.36
|
| Rate for Payer: First Health Commercial |
$1,037.40
|
| Rate for Payer: Humana Commercial |
$928.20
|
| Rate for Payer: Humana KY Medicaid |
$375.54
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$379.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.96
|
| Rate for Payer: Ohio Health Group HMO |
$819.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.52
|
| Rate for Payer: PHCS Commercial |
$1,048.32
|
| Rate for Payer: United Healthcare All Payer |
$960.96
|
|
|
DRESSING CHANGE /NOT BURN
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DRESSING CHANGE /NOT BURN(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
761P0227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$71.57
|
| Rate for Payer: Anthem Medicaid |
$32.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$67.65
|
| Rate for Payer: Healthspan PPO |
$57.23
|
| Rate for Payer: Humana Medicaid |
$32.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Passport |
$32.84
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.17
|
|
|
DRESSING CHANGE /NOT BURN(T
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
761T0227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DRESSING CHANGE /NOT BURN(T
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 15852
|
| Hospital Charge Code |
761T0227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DRESSING VERAFLO LG
|
Facility
|
IP
|
$2,106.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.78 |
| Max. Negotiated Rate |
$2,021.76 |
| Rate for Payer: Aetna Commercial |
$1,621.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.68
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$1,747.98
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Humana Commercial |
$1,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,853.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.86
|
| Rate for Payer: PHCS Commercial |
$2,021.76
|
| Rate for Payer: United Healthcare All Payer |
$1,853.28
|
|
|
DRESSING VERAFLO LG
|
Facility
|
OP
|
$2,106.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.78 |
| Max. Negotiated Rate |
$2,021.76 |
| Rate for Payer: Aetna Commercial |
$1,621.62
|
| Rate for Payer: Anthem Medicaid |
$724.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.68
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$1,747.98
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Humana Commercial |
$1,790.10
|
| Rate for Payer: Humana KY Medicaid |
$724.25
|
| Rate for Payer: Kentucky WC Medicaid |
$731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,853.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.86
|
| Rate for Payer: PHCS Commercial |
$2,021.76
|
| Rate for Payer: United Healthcare All Payer |
$1,853.28
|
|
|
DRESSING VERAFLO MED
|
Facility
|
IP
|
$1,752.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
DRESSING VERAFLO MED
|
Facility
|
OP
|
$1,752.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
DRESSING VERAFLO SM
|
Facility
|
OP
|
$1,593.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem Medicaid |
$547.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Humana KY Medicaid |
$547.83
|
| Rate for Payer: Kentucky WC Medicaid |
$553.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
DRESSING VERAFLO SM
|
Facility
|
IP
|
$1,593.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
45000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$61.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$61.56
|
| Rate for Payer: Kentucky WC Medicaid |
$62.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.49
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
45000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.49
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
76102551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
76102551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
DRILL BIT 1.3MM
|
Facility
|
OP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
DRILL BIT 1.3MM
|
Facility
|
IP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
DRILL BIT 1.6MM
|
Facility
|
OP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
DRILL BIT 1.6MM
|
Facility
|
IP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
DRILL BIT 2.0MM
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
DRILL BIT 2.0MM
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
DRILL BIT 2.4
|
Facility
|
OP
|
$2,016.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.09 |
| Max. Negotiated Rate |
$1,935.41 |
| Rate for Payer: Aetna Commercial |
$1,552.36
|
| Rate for Payer: Anthem Medicaid |
$693.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,572.52
|
| Rate for Payer: Cash Price |
$1,008.02
|
| Rate for Payer: Cigna Commercial |
$1,673.32
|
| Rate for Payer: First Health Commercial |
$1,915.25
|
| Rate for Payer: Humana Commercial |
$1,713.64
|
| Rate for Payer: Humana KY Medicaid |
$693.32
|
| Rate for Payer: Kentucky WC Medicaid |
$700.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,653.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,774.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.98
|
| Rate for Payer: PHCS Commercial |
$1,935.41
|
| Rate for Payer: United Healthcare All Payer |
$1,774.12
|
|
