|
DRILL BIT QUICK RELEASE 1/8 IN
|
Facility
|
OP
|
$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 Medicaid |
$585.70
|
| 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: Humana KY Medicaid |
$585.70
|
| Rate for Payer: Kentucky WC Medicaid |
$591.66
|
| 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: Molina Healthcare Medicaid |
$597.45
|
| 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
|
|
|
DRILL NON-CANN 4MM
|
Facility
|
IP
|
$1,737.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
DRILL NON-CANN 4MM
|
Facility
|
OP
|
$1,737.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
DRILL PIN NIT 1.7
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
DRILL PIN NIT 1.7
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
DRILL REFLECTION FLEX 35MM
|
Facility
|
OP
|
$1,989.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.74 |
| Max. Negotiated Rate |
$1,909.56 |
| Rate for Payer: Aetna Commercial |
$1,531.63
|
| Rate for Payer: Anthem Medicaid |
$684.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.52
|
| Rate for Payer: Cash Price |
$994.57
|
| Rate for Payer: Cigna Commercial |
$1,650.98
|
| Rate for Payer: First Health Commercial |
$1,889.67
|
| Rate for Payer: Humana Commercial |
$1,690.76
|
| Rate for Payer: Humana KY Medicaid |
$684.06
|
| Rate for Payer: Kentucky WC Medicaid |
$691.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.50
|
| Rate for Payer: PHCS Commercial |
$1,909.56
|
| Rate for Payer: United Healthcare All Payer |
$1,750.43
|
|
|
DRILL REFLECTION FLEX 35MM
|
Facility
|
IP
|
$1,989.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.74 |
| Max. Negotiated Rate |
$1,909.56 |
| Rate for Payer: Aetna Commercial |
$1,531.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.52
|
| Rate for Payer: Cash Price |
$994.57
|
| Rate for Payer: Cigna Commercial |
$1,650.98
|
| Rate for Payer: First Health Commercial |
$1,889.67
|
| Rate for Payer: Humana Commercial |
$1,690.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.50
|
| Rate for Payer: PHCS Commercial |
$1,909.56
|
| Rate for Payer: United Healthcare All Payer |
$1,750.43
|
|
|
DRIVER STAR 7
|
Facility
|
OP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem Medicaid |
$592.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Humana KY Medicaid |
$592.13
|
| Rate for Payer: Kentucky WC Medicaid |
$598.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
DRIVER STAR 7
|
Facility
|
IP
|
$1,721.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.54 |
| Max. Negotiated Rate |
$1,652.93 |
| Rate for Payer: Aetna Commercial |
$1,325.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.00
|
| Rate for Payer: Cash Price |
$860.90
|
| Rate for Payer: Cigna Commercial |
$1,429.09
|
| Rate for Payer: First Health Commercial |
$1,635.71
|
| Rate for Payer: Humana Commercial |
$1,463.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.04
|
| Rate for Payer: PHCS Commercial |
$1,652.93
|
| Rate for Payer: United Healthcare All Payer |
$1,515.18
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.70 |
| Max. Negotiated Rate |
$1,103.04 |
| Rate for Payer: Aetna Commercial |
$884.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.22
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cigna Commercial |
$953.67
|
| Rate for Payer: First Health Commercial |
$1,091.55
|
| Rate for Payer: Humana Commercial |
$976.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$847.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.12
|
| Rate for Payer: Ohio Health Group HMO |
$861.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$792.81
|
| Rate for Payer: PHCS Commercial |
$1,103.04
|
| Rate for Payer: United Healthcare All Payer |
$1,011.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
45000305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.70 |
| Max. Negotiated Rate |
$863.04 |
| Rate for Payer: Aetna Commercial |
$692.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$701.22
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$746.17
|
| Rate for Payer: First Health Commercial |
$854.05
|
| Rate for Payer: Humana Commercial |
$764.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$791.12
|
| Rate for Payer: Ohio Health Group HMO |
$674.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$782.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.31
|
| Rate for Payer: PHCS Commercial |
$863.04
|
| Rate for Payer: United Healthcare All Payer |
$791.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.14 |
| Max. Negotiated Rate |
$1,103.04 |
| Rate for Payer: Aetna Commercial |
$884.73
|
| Rate for Payer: Anthem Medicaid |
$395.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cigna Commercial |
$953.67
|
| Rate for Payer: First Health Commercial |
$1,091.55
|
| Rate for Payer: Humana Commercial |
$976.65
|
| Rate for Payer: Humana KY Medicaid |
$395.14
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$399.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$847.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.12
|
| Rate for Payer: Ohio Health Group HMO |
$861.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$792.81
|
| Rate for Payer: PHCS Commercial |
$1,103.04
|
| Rate for Payer: United Healthcare All Payer |
$1,011.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Professional
|
Both
|
$1,149.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Ambetter Exchange |
$117.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.50
|
| Rate for Payer: Anthem Medicaid |
$51.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.59
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cigna Commercial |
$247.63
|
| Rate for Payer: Healthspan PPO |
$219.11
|
| Rate for Payer: Humana Medicaid |
$51.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.22
|
| Rate for Payer: Molina Healthcare Passport |
$51.20
|
| Rate for Payer: Multiplan PHCS |
$689.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.31
|
| Rate for Payer: UHCCP Medicaid |
$66.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.16
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
45000305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.17 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Aetna Commercial |
$692.23
|
| Rate for Payer: Anthem Medicaid |
$309.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$701.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$746.17
|
| Rate for Payer: First Health Commercial |
$854.05
|
| Rate for Payer: Humana Commercial |
$764.15
|
| Rate for Payer: Humana KY Medicaid |
$309.17
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$312.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$791.12
|
| Rate for Payer: Ohio Health Group HMO |
$674.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$782.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.31
|
| Rate for Payer: PHCS Commercial |
$863.04
|
| Rate for Payer: United Healthcare All Payer |
$791.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761P2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$247.63 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Ambetter Exchange |
$117.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.50
|
| Rate for Payer: Anthem Medicaid |
$51.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.59
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$247.63
|
| Rate for Payer: Healthspan PPO |
$219.11
|
| Rate for Payer: Humana Medicaid |
$51.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.22
|
| Rate for Payer: Molina Healthcare Passport |
$51.20
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.31
|
| Rate for Payer: UHCCP Medicaid |
$66.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.16
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(T
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761T2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.70 |
| Max. Negotiated Rate |
$863.04 |
| Rate for Payer: Aetna Commercial |
$692.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$701.22
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$746.17
|
| Rate for Payer: First Health Commercial |
$854.05
|
| Rate for Payer: Humana Commercial |
$764.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$791.12
|
| Rate for Payer: Ohio Health Group HMO |
$674.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$782.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.31
|
| Rate for Payer: PHCS Commercial |
$863.04
|
| Rate for Payer: United Healthcare All Payer |
$791.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(T
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761T2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.17 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Aetna Commercial |
$692.23
|
| Rate for Payer: Anthem Medicaid |
$309.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$701.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$746.17
|
| Rate for Payer: First Health Commercial |
$854.05
|
| Rate for Payer: Humana Commercial |
$764.15
|
| Rate for Payer: Humana KY Medicaid |
$309.17
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$312.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$791.12
|
| Rate for Payer: Ohio Health Group HMO |
$674.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$782.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.31
|
| Rate for Payer: PHCS Commercial |
$863.04
|
| Rate for Payer: United Healthcare All Payer |
$791.12
|
|
|
DROPERIDOL 2.5MG SDV
|
Facility
|
OP
|
$26.38
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004554
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Aetna Commercial |
$20.31
|
| Rate for Payer: Anthem Medicaid |
$9.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.58
|
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Cigna Commercial |
$21.90
|
| Rate for Payer: First Health Commercial |
$25.06
|
| Rate for Payer: Humana Commercial |
$22.42
|
| Rate for Payer: Humana KY Medicaid |
$9.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.21
|
| Rate for Payer: Ohio Health Group HMO |
$19.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.20
|
| Rate for Payer: PHCS Commercial |
$25.32
|
| Rate for Payer: United Healthcare All Payer |
$23.21
|
|
|
DROPERIDOL 2.5MG SDV
|
Facility
|
IP
|
$26.38
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004554
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Aetna Commercial |
$20.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.58
|
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Cigna Commercial |
$21.90
|
| Rate for Payer: First Health Commercial |
$25.06
|
| Rate for Payer: Humana Commercial |
$22.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.21
|
| Rate for Payer: Ohio Health Group HMO |
$19.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.20
|
| Rate for Payer: PHCS Commercial |
$25.32
|
| Rate for Payer: United Healthcare All Payer |
$23.21
|
|
|
DROPERIDOL 5mg SDV
|
Facility
|
IP
|
$24.42
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.05
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna Commercial |
$20.27
|
| Rate for Payer: First Health Commercial |
$23.20
|
| Rate for Payer: Humana Commercial |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.49
|
| Rate for Payer: Ohio Health Group HMO |
$18.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.85
|
| Rate for Payer: PHCS Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Payer |
$21.49
|
|
|
DROPERIDOL 5mg SDV
|
Facility
|
OP
|
$24.42
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Anthem Medicaid |
$8.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.05
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna Commercial |
$20.27
|
| Rate for Payer: First Health Commercial |
$23.20
|
| Rate for Payer: Humana Commercial |
$20.76
|
| Rate for Payer: Humana KY Medicaid |
$8.40
|
| Rate for Payer: Kentucky WC Medicaid |
$8.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.49
|
| Rate for Payer: Ohio Health Group HMO |
$18.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.85
|
| Rate for Payer: PHCS Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Payer |
$21.49
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Ambetter Exchange |
$125.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.85
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$240.92
|
| Rate for Payer: Healthspan PPO |
$198.68
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$464.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.42
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.71
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.01 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem Medicaid |
$163.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Humana KY Medicaid |
$163.01
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$164.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761P0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$240.92 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Ambetter Exchange |
$125.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.85
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$240.92
|
| Rate for Payer: Healthspan PPO |
$198.68
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.42
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.71
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: Aetna Commercial |
$595.98
|
| Rate for Payer: Anthem Medicaid |
$266.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$642.42
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: Humana Commercial |
$657.90
|
| Rate for Payer: Humana KY Medicaid |
$266.18
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$268.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.12
|
| Rate for Payer: Ohio Health Group HMO |
$580.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.06
|
| Rate for Payer: PHCS Commercial |
$743.04
|
| Rate for Payer: United Healthcare All Payer |
$681.12
|
|
