|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
76102551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| 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 |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
DRESS/OR DETRIME BUR W/O ANES
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
45000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.70 |
| 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 |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
DRILL BIT 1.3MM
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT 1.3MM
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT 1.6MM
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT 1.6MM
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT 2.0MM
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
DRILL BIT 2.0MM
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
DRILL BIT 2.4
|
Facility
|
OP
|
$2,023.14
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.94 |
| Max. Negotiated Rate |
$1,942.21 |
| Rate for Payer: Aetna Commercial |
$1,557.82
|
| Rate for Payer: Anthem Medicaid |
$695.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.05
|
| Rate for Payer: Cash Price |
$1,011.57
|
| Rate for Payer: Cigna Commercial |
$1,679.21
|
| Rate for Payer: First Health Commercial |
$1,921.98
|
| Rate for Payer: Humana Commercial |
$1,719.67
|
| Rate for Payer: Humana KY Medicaid |
$695.76
|
| Rate for Payer: Kentucky WC Medicaid |
$702.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.97
|
| Rate for Payer: PHCS Commercial |
$1,942.21
|
| Rate for Payer: United Healthcare All Payer |
$1,780.36
|
|
|
DRILL BIT 2.4
|
Facility
|
IP
|
$2,023.14
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.94 |
| Max. Negotiated Rate |
$1,942.21 |
| Rate for Payer: Aetna Commercial |
$1,557.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.05
|
| Rate for Payer: Cash Price |
$1,011.57
|
| Rate for Payer: Cigna Commercial |
$1,679.21
|
| Rate for Payer: First Health Commercial |
$1,921.98
|
| Rate for Payer: Humana Commercial |
$1,719.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.97
|
| Rate for Payer: PHCS Commercial |
$1,942.21
|
| Rate for Payer: United Healthcare All Payer |
$1,780.36
|
|
|
DRILL BIT 2.4MM
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
DRILL BIT 2.4MM
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
DRILL BIT 3.2*230MM
|
Facility
|
OP
|
$3,315.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.76 |
| Max. Negotiated Rate |
$3,183.24 |
| Rate for Payer: Aetna Commercial |
$2,553.23
|
| Rate for Payer: Anthem Medicaid |
$1,140.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.39
|
| Rate for Payer: Cash Price |
$1,657.94
|
| Rate for Payer: Cigna Commercial |
$2,752.18
|
| Rate for Payer: First Health Commercial |
$3,150.09
|
| Rate for Payer: Humana Commercial |
$2,818.50
|
| Rate for Payer: Humana KY Medicaid |
$1,140.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,151.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,917.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,486.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,652.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,884.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,287.96
|
| Rate for Payer: PHCS Commercial |
$3,183.24
|
| Rate for Payer: United Healthcare All Payer |
$2,917.97
|
|
|
DRILL BIT 3.2*230MM
|
Facility
|
IP
|
$3,315.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.76 |
| Max. Negotiated Rate |
$3,183.24 |
| Rate for Payer: Aetna Commercial |
$2,553.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.39
|
| Rate for Payer: Cash Price |
$1,657.94
|
| Rate for Payer: Cigna Commercial |
$2,752.18
|
| Rate for Payer: First Health Commercial |
$3,150.09
|
| Rate for Payer: Humana Commercial |
$2,818.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,917.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,486.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,652.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,884.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,287.96
|
| Rate for Payer: PHCS Commercial |
$3,183.24
|
| Rate for Payer: United Healthcare All Payer |
$2,917.97
|
|
|
DRILL BIT AO/QC 1.6MM
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT AO/QC 1.6MM
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT AO/QC 1.8MM
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT AO/QC 1.8MM
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
DRILL BIT AO ��1.7MM
|
Facility
|
OP
|
$1,908.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
DRILL BIT AO ��1.7MM
|
Facility
|
IP
|
$1,908.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
DRILL BIT CANN 2.75*.066
|
Facility
|
IP
|
$3,312.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
DRILL BIT CANN 2.75*.066
|
Facility
|
OP
|
$3,312.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
DRILL BIT CROWE PT 4.3M*18C
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.70 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.41
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
DRILL BIT CROWE PT 4.3M*18C
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.70 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.41
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
DRILL BIT QUICK RELEASE 1/8 IN
|
Facility
|
IP
|
$1,703.10
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.93 |
| Max. Negotiated Rate |
$1,634.98 |
| Rate for Payer: Aetna Commercial |
$1,311.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.42
|
| Rate for Payer: Cash Price |
$851.55
|
| Rate for Payer: Cigna Commercial |
$1,413.57
|
| Rate for Payer: First Health Commercial |
$1,617.94
|
| Rate for Payer: Humana Commercial |
$1,447.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,362.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,481.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,175.14
|
| Rate for Payer: PHCS Commercial |
$1,634.98
|
| Rate for Payer: United Healthcare All Payer |
$1,498.73
|
|
