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
|
|
DRILL BIT 2.4MM
|
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: 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
|
Rate for Payer: Aetna Commercial |
$2,397.40
|
Rate for Payer: Anthem Medicaid |
$1,070.73
|
|
DRILL BIT 2.4MM
|
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 3.2*230MM
|
Facility
|
IP
|
$3,428.15
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$445.66 |
Max. Negotiated Rate |
$3,291.02 |
Rate for Payer: Aetna Commercial |
$2,639.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.96
|
Rate for Payer: Cash Price |
$1,714.08
|
Rate for Payer: Cigna Commercial |
$2,845.36
|
Rate for Payer: First Health Commercial |
$3,256.74
|
Rate for Payer: Humana Commercial |
$2,913.93
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.08
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.44
|
Rate for Payer: Ohio Health Choice Commercial |
$3,016.77
|
Rate for Payer: Ohio Health Group HMO |
$2,571.11
|
Rate for Payer: Ohio Health Group PPO Differential |
$685.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$445.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.73
|
Rate for Payer: PHCS Commercial |
$3,291.02
|
Rate for Payer: United Healthcare All Payer |
$3,016.77
|
|
DRILL BIT 3.2*230MM
|
Facility
|
OP
|
$3,428.15
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$445.66 |
Max. Negotiated Rate |
$3,291.02 |
Rate for Payer: Aetna Commercial |
$2,639.68
|
Rate for Payer: Anthem Medicaid |
$1,178.94
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.96
|
Rate for Payer: Cash Price |
$1,714.08
|
Rate for Payer: Cigna Commercial |
$2,845.36
|
Rate for Payer: First Health Commercial |
$3,256.74
|
Rate for Payer: Humana Commercial |
$2,913.93
|
Rate for Payer: Humana KY Medicaid |
$1,178.94
|
Rate for Payer: Kentucky WC Medicaid |
$1,190.94
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.08
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.44
|
Rate for Payer: Molina Healthcare Medicaid |
$1,202.60
|
Rate for Payer: Ohio Health Choice Commercial |
$3,016.77
|
Rate for Payer: Ohio Health Group HMO |
$2,571.11
|
Rate for Payer: Ohio Health Group PPO Differential |
$685.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$445.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.73
|
Rate for Payer: PHCS Commercial |
$3,291.02
|
Rate for Payer: United Healthcare All Payer |
$3,016.77
|
|
DRILL BIT AO Ø1.7MM
|
Facility
|
OP
|
$1,910.00
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$248.30 |
Max. Negotiated Rate |
$1,833.60 |
Rate for Payer: Aetna Commercial |
$1,470.70
|
Rate for Payer: Anthem Medicaid |
$656.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
Rate for Payer: Cash Price |
$955.00
|
Rate for Payer: Cigna Commercial |
$1,585.30
|
Rate for Payer: First Health Commercial |
$1,814.50
|
Rate for Payer: Humana Commercial |
$1,623.50
|
Rate for Payer: Humana KY Medicaid |
$656.85
|
Rate for Payer: Kentucky WC Medicaid |
$663.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
Rate for Payer: Molina Healthcare Medicaid |
$670.03
|
Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
Rate for Payer: PHCS Commercial |
$1,833.60
|
Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
DRILL BIT AO Ø1.7MM
|
Facility
|
IP
|
$1,910.00
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$248.30 |
Max. Negotiated Rate |
$1,833.60 |
Rate for Payer: Aetna Commercial |
$1,470.70
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
Rate for Payer: Cash Price |
$955.00
|
Rate for Payer: Cigna Commercial |
$1,585.30
|
Rate for Payer: First Health Commercial |
$1,814.50
|
Rate for Payer: Humana Commercial |
$1,623.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
Rate for Payer: PHCS Commercial |
$1,833.60
|
Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
DRILL BIT AO/QC 1.6MM
|
Facility
|
OP
|
$1,717.50
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
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 AO/QC 1.6MM
|
Facility
|
IP
|
$1,717.50
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
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 AO/QC 1.9MM
|
Facility
|
IP
|
$1,717.50
|
|
Service Code
|
HCPCS L2795
|
Hospital Charge Code |
27000024
|
Hospital Revenue Code
|
272
|
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 AO/QC 1.9MM
|
Facility
|
OP
|
$1,717.50
|
|
Service Code
|
HCPCS L2795
|
Hospital Charge Code |
27000024
|
Hospital Revenue Code
|
272
|
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 CANN 2.75*.066
|
Facility
|
IP
|
$3,425.00
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$445.25 |
Max. Negotiated Rate |
$3,288.00 |
Rate for Payer: Aetna Commercial |
$2,637.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
Rate for Payer: Cash Price |
$1,712.50
|
Rate for Payer: Cigna Commercial |
$2,842.75
|
Rate for Payer: First Health Commercial |
$3,253.75
|
Rate for Payer: Humana Commercial |
$2,911.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
Rate for Payer: PHCS Commercial |
$3,288.00
|
Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
DRILL BIT CANN 2.75*.066
|
Facility
|
OP
|
$3,425.00
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$445.25 |
Max. Negotiated Rate |
$3,288.00 |
Rate for Payer: Aetna Commercial |
$2,637.25
|
Rate for Payer: Anthem Medicaid |
$1,177.86
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
Rate for Payer: Cash Price |
$1,712.50
|
Rate for Payer: Cigna Commercial |
$2,842.75
|
Rate for Payer: First Health Commercial |
$3,253.75
|
Rate for Payer: Humana Commercial |
$2,911.25
|
Rate for Payer: Humana KY Medicaid |
$1,177.86
|
Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
Rate for Payer: PHCS Commercial |
$3,288.00
|
Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
DRILL BIT CROWE PT 4.3M*18C
|
Facility
|
IP
|
$1,892.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$246.02 |
Max. Negotiated Rate |
$1,816.80 |
Rate for Payer: Aetna Commercial |
$1,457.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
Rate for Payer: Cash Price |
$946.25
|
Rate for Payer: Cigna Commercial |
$1,570.78
|
Rate for Payer: First Health Commercial |
$1,797.88
|
Rate for Payer: Humana Commercial |
$1,608.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
Rate for Payer: PHCS Commercial |
$1,816.80
|
Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
DRILL BIT CROWE PT 4.3M*18C
|
Facility
|
OP
|
$1,892.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$246.02 |
Max. Negotiated Rate |
$1,816.80 |
Rate for Payer: Aetna Commercial |
$1,457.22
|
Rate for Payer: Anthem Medicaid |
$650.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
Rate for Payer: Cash Price |
$946.25
|
Rate for Payer: Cigna Commercial |
$1,570.78
|
Rate for Payer: First Health Commercial |
$1,797.88
|
Rate for Payer: Humana Commercial |
$1,608.62
|
Rate for Payer: Humana KY Medicaid |
$650.83
|
Rate for Payer: Kentucky WC Medicaid |
$657.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
Rate for Payer: PHCS Commercial |
$1,816.80
|
Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
DRILL BIT QUICK RELEASE 1/8 IN
|
Facility
|
OP
|
$1,721.28
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$223.77 |
Max. Negotiated Rate |
$1,652.43 |
Rate for Payer: Aetna Commercial |
$1,325.39
|
Rate for Payer: Anthem Medicaid |
$591.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.60
|
Rate for Payer: Cash Price |
$860.64
|
Rate for Payer: Cigna Commercial |
$1,428.66
|
Rate for Payer: First Health Commercial |
$1,635.22
|
Rate for Payer: Humana Commercial |
$1,463.09
|
Rate for Payer: Humana KY Medicaid |
$591.95
|
Rate for Payer: Kentucky WC Medicaid |
$597.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.30
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$516.38
|
Rate for Payer: Molina Healthcare Medicaid |
$603.83
|
Rate for Payer: Ohio Health Choice Commercial |
$1,514.73
|
Rate for Payer: Ohio Health Group HMO |
$1,290.96
|
Rate for Payer: Ohio Health Group PPO Differential |
$344.26
|
Rate for Payer: Ohio Health Group PPO No Differential |
$223.77
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.60
|
Rate for Payer: PHCS Commercial |
$1,652.43
|
Rate for Payer: United Healthcare All Payer |
$1,514.73
|
|
DRILL BIT QUICK RELEASE 1/8 IN
|
Facility
|
IP
|
$1,721.28
|
|
Hospital Charge Code |
27000242
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$223.77 |
Max. Negotiated Rate |
$1,652.43 |
Rate for Payer: Aetna Commercial |
$1,325.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.60
|
Rate for Payer: Cash Price |
$860.64
|
Rate for Payer: Cigna Commercial |
$1,428.66
|
Rate for Payer: First Health Commercial |
$1,635.22
|
Rate for Payer: Humana Commercial |
$1,463.09
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.30
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$516.38
|
Rate for Payer: Ohio Health Choice Commercial |
$1,514.73
|
Rate for Payer: Ohio Health Group HMO |
$1,290.96
|
Rate for Payer: Ohio Health Group PPO Differential |
$344.26
|
Rate for Payer: Ohio Health Group PPO No Differential |
$223.77
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.60
|
Rate for Payer: PHCS Commercial |
$1,652.43
|
Rate for Payer: United Healthcare All Payer |
$1,514.73
|
|
DRILL NON-CANN 4MM
|
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
|
|
DRILL NON-CANN 4MM
|
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
|
|
DRILL REFLECTION FLEX 35MM
|
Facility
|
OP
|
$1,984.72
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$258.01 |
Max. Negotiated Rate |
$1,905.33 |
Rate for Payer: Aetna Commercial |
$1,528.23
|
Rate for Payer: Anthem Medicaid |
$682.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.08
|
Rate for Payer: Cash Price |
$992.36
|
Rate for Payer: Cigna Commercial |
$1,647.32
|
Rate for Payer: First Health Commercial |
$1,885.48
|
Rate for Payer: Humana Commercial |
$1,687.01
|
Rate for Payer: Humana KY Medicaid |
$682.55
|
Rate for Payer: Kentucky WC Medicaid |
$689.49
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$595.42
|
Rate for Payer: Molina Healthcare Medicaid |
$696.24
|
Rate for Payer: Ohio Health Choice Commercial |
$1,746.55
|
Rate for Payer: Ohio Health Group HMO |
$1,488.54
|
Rate for Payer: Ohio Health Group PPO Differential |
$396.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$258.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.26
|
Rate for Payer: PHCS Commercial |
$1,905.33
|
Rate for Payer: United Healthcare All Payer |
$1,746.55
|
|
DRILL REFLECTION FLEX 35MM
|
Facility
|
IP
|
$1,984.72
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$258.01 |
Max. Negotiated Rate |
$1,905.33 |
Rate for Payer: Aetna Commercial |
$1,528.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.08
|
Rate for Payer: Cash Price |
$992.36
|
Rate for Payer: Cigna Commercial |
$1,647.32
|
Rate for Payer: First Health Commercial |
$1,885.48
|
Rate for Payer: Humana Commercial |
$1,687.01
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$595.42
|
Rate for Payer: Ohio Health Choice Commercial |
$1,746.55
|
Rate for Payer: Ohio Health Group HMO |
$1,488.54
|
Rate for Payer: Ohio Health Group PPO Differential |
$396.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$258.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.26
|
Rate for Payer: PHCS Commercial |
$1,905.33
|
Rate for Payer: United Healthcare All Payer |
$1,746.55
|
|
DRIVER STAR 7
|
Facility
|
IP
|
$1,738.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$226.00 |
Max. Negotiated Rate |
$1,668.96 |
Rate for Payer: Aetna Commercial |
$1,338.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
Rate for Payer: Cash Price |
$869.25
|
Rate for Payer: Cigna Commercial |
$1,442.96
|
Rate for Payer: First Health Commercial |
$1,651.58
|
Rate for Payer: Humana Commercial |
$1,477.72
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
Rate for Payer: PHCS Commercial |
$1,668.96
|
Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
DRIVER STAR 7
|
Facility
|
OP
|
$1,738.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$226.00 |
Max. Negotiated Rate |
$1,668.96 |
Rate for Payer: Aetna Commercial |
$1,338.64
|
Rate for Payer: Anthem Medicaid |
$597.87
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
Rate for Payer: Cash Price |
$869.25
|
Rate for Payer: Cigna Commercial |
$1,442.96
|
Rate for Payer: First Health Commercial |
$1,651.58
|
Rate for Payer: Humana Commercial |
$1,477.72
|
Rate for Payer: Humana KY Medicaid |
$597.87
|
Rate for Payer: Kentucky WC Medicaid |
$603.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
Rate for Payer: Molina Healthcare Medicaid |
$609.87
|
Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
Rate for Payer: PHCS Commercial |
$1,668.96
|
Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
OP
|
$1,124.00
|
|
Service Code
|
HCPCS 69000
|
Hospital Charge Code |
76102401
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$146.12 |
Max. Negotiated Rate |
$1,079.04 |
Rate for Payer: Aetna Commercial |
$865.48
|
Rate for Payer: Anthem Medicaid |
$386.54
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
Rate for Payer: Anthem POS/PPO/Traditional |
$876.72
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
Rate for Payer: Cash Price |
$562.00
|
Rate for Payer: Cash Price |
$562.00
|
Rate for Payer: Cigna Commercial |
$932.92
|
Rate for Payer: First Health Commercial |
$1,067.80
|
Rate for Payer: Humana Commercial |
$955.40
|
Rate for Payer: Humana KY Medicaid |
$386.54
|
Rate for Payer: Humana Medicare Advantage |
$608.42
|
Rate for Payer: Kentucky WC Medicaid |
$390.48
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$921.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.51
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
Rate for Payer: Molina Healthcare Medicaid |
$394.30
|
Rate for Payer: Ohio Health Choice Commercial |
$989.12
|
Rate for Payer: Ohio Health Group HMO |
$843.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$146.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.44
|
Rate for Payer: PHCS Commercial |
$1,079.04
|
Rate for Payer: United Healthcare All Payer |
$989.12
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Professional
|
Both
|
$1,124.00
|
|
Service Code
|
HCPCS 69000
|
Hospital Charge Code |
76102401
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$46.50 |
Max. Negotiated Rate |
$1,124.00 |
Rate for Payer: Aetna Commercial |
$165.67
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.50
|
Rate for Payer: Anthem Medicaid |
$46.50
|
Rate for Payer: Buckeye Medicare Advantage |
$1,124.00
|
Rate for Payer: Cash Price |
$562.00
|
Rate for Payer: Cash Price |
$562.00
|
Rate for Payer: Cigna Commercial |
$247.63
|
Rate for Payer: Healthspan PPO |
$219.11
|
Rate for Payer: Humana Medicaid |
$46.50
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.53
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.43
|
Rate for Payer: Molina Healthcare Passport |
$46.50
|
Rate for Payer: Multiplan PHCS |
$674.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$786.80
|
Rate for Payer: UHCCP Medicaid |
$66.68
|
Rate for Payer: Wellcare CHIP/Medicaid |
$46.96
|
|