|
FILTER TRAPEASE
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
FILTER TRAPEASE
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
FILTER WIRE 190CM 2.25-3.5
|
Facility
|
IP
|
$7,381.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.55 |
| Max. Negotiated Rate |
$7,086.55 |
| Rate for Payer: Aetna Commercial |
$5,684.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,757.82
|
| Rate for Payer: Cash Price |
$3,690.91
|
| Rate for Payer: Cigna Commercial |
$6,126.91
|
| Rate for Payer: First Health Commercial |
$7,012.73
|
| Rate for Payer: Humana Commercial |
$6,274.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,447.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,905.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,422.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,093.46
|
| Rate for Payer: PHCS Commercial |
$7,086.55
|
| Rate for Payer: United Healthcare All Payer |
$6,496.00
|
|
|
FILTER WIRE 190CM 2.25-3.5
|
Facility
|
OP
|
$7,381.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.55 |
| Max. Negotiated Rate |
$7,086.55 |
| Rate for Payer: Aetna Commercial |
$5,684.00
|
| Rate for Payer: Anthem Medicaid |
$2,538.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,757.82
|
| Rate for Payer: Cash Price |
$3,690.91
|
| Rate for Payer: Cigna Commercial |
$6,126.91
|
| Rate for Payer: First Health Commercial |
$7,012.73
|
| Rate for Payer: Humana Commercial |
$6,274.55
|
| Rate for Payer: Humana KY Medicaid |
$2,538.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,447.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,905.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,422.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,093.46
|
| Rate for Payer: PHCS Commercial |
$7,086.55
|
| Rate for Payer: United Healthcare All Payer |
$6,496.00
|
|
|
FILTER WIRE EZ 190CM
|
Facility
|
IP
|
$7,118.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,135.68 |
| Max. Negotiated Rate |
$6,834.16 |
| Rate for Payer: Aetna Commercial |
$5,481.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.76
|
| Rate for Payer: Cash Price |
$3,559.46
|
| Rate for Payer: Cigna Commercial |
$5,908.70
|
| Rate for Payer: First Health Commercial |
$6,762.97
|
| Rate for Payer: Humana Commercial |
$6,051.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,264.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.05
|
| Rate for Payer: PHCS Commercial |
$6,834.16
|
| Rate for Payer: United Healthcare All Payer |
$6,264.65
|
|
|
FILTER WIRE EZ 190CM
|
Facility
|
OP
|
$7,118.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,135.68 |
| Max. Negotiated Rate |
$6,834.16 |
| Rate for Payer: Aetna Commercial |
$5,481.57
|
| Rate for Payer: Anthem Medicaid |
$2,448.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.76
|
| Rate for Payer: Cash Price |
$3,559.46
|
| Rate for Payer: Cigna Commercial |
$5,908.70
|
| Rate for Payer: First Health Commercial |
$6,762.97
|
| Rate for Payer: Humana Commercial |
$6,051.08
|
| Rate for Payer: Humana KY Medicaid |
$2,448.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,264.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.05
|
| Rate for Payer: PHCS Commercial |
$6,834.16
|
| Rate for Payer: United Healthcare All Payer |
$6,264.65
|
|
|
FILTER WIRE EZ 300CM
|
Facility
|
OP
|
$7,118.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,135.68 |
| Max. Negotiated Rate |
$6,834.16 |
| Rate for Payer: Aetna Commercial |
$5,481.57
|
| Rate for Payer: Anthem Medicaid |
$2,448.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.76
|
| Rate for Payer: Cash Price |
$3,559.46
|
| Rate for Payer: Cigna Commercial |
$5,908.70
|
| Rate for Payer: First Health Commercial |
$6,762.97
|
| Rate for Payer: Humana Commercial |
$6,051.08
|
| Rate for Payer: Humana KY Medicaid |
$2,448.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,264.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.05
|
| Rate for Payer: PHCS Commercial |
$6,834.16
|
| Rate for Payer: United Healthcare All Payer |
$6,264.65
|
|
|
FILTER WIRE EZ 300CM
|
Facility
|
IP
|
$7,118.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,135.68 |
| Max. Negotiated Rate |
$6,834.16 |
| Rate for Payer: Aetna Commercial |
$5,481.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,552.76
|
| Rate for Payer: Cash Price |
$3,559.46
|
| Rate for Payer: Cigna Commercial |
$5,908.70
|
| Rate for Payer: First Health Commercial |
$6,762.97
|
| Rate for Payer: Humana Commercial |
$6,051.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,253.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,264.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.05
|
| Rate for Payer: PHCS Commercial |
$6,834.16
|
| Rate for Payer: United Healthcare All Payer |
$6,264.65
|
|
|
FINE CROSS M3 150CM
|
Facility
|
IP
|
$4,448.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,334.62 |
| Max. Negotiated Rate |
$4,270.80 |
| Rate for Payer: Aetna Commercial |
$3,425.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,470.03
|
| Rate for Payer: Cash Price |
$2,224.38
|
| Rate for Payer: Cigna Commercial |
$3,692.46
|
| Rate for Payer: First Health Commercial |
$4,226.31
|
| Rate for Payer: Humana Commercial |
$3,781.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,283.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,559.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,870.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.64
|
| Rate for Payer: PHCS Commercial |
$4,270.80
|
| Rate for Payer: United Healthcare All Payer |
$3,914.90
|
|
|
FINE CROSS M3 150CM
|
Facility
|
OP
|
$4,448.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,334.62 |
| Max. Negotiated Rate |
$4,270.80 |
| Rate for Payer: Aetna Commercial |
$3,425.54
|
| Rate for Payer: Anthem Medicaid |
$1,529.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,470.03
|
| Rate for Payer: Cash Price |
$2,224.38
|
| Rate for Payer: Cigna Commercial |
$3,692.46
|
| Rate for Payer: First Health Commercial |
$4,226.31
|
| Rate for Payer: Humana Commercial |
$3,781.44
|
| Rate for Payer: Humana KY Medicaid |
$1,529.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,283.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,559.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,870.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.64
|
| Rate for Payer: PHCS Commercial |
$4,270.80
|
| Rate for Payer: United Healthcare All Payer |
$3,914.90
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.99
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Ambetter Exchange |
$52.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.77
|
| Rate for Payer: Anthem Medicaid |
$65.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$190.98
|
| Rate for Payer: Healthspan PPO |
$156.33
|
| Rate for Payer: Humana Medicaid |
$65.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.69
|
| Rate for Payer: Molina Healthcare Passport |
$65.38
|
| Rate for Payer: Multiplan PHCS |
$642.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.83
|
| Rate for Payer: UHCCP Medicaid |
$52.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.18
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.32 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem Medicaid |
$368.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Humana KY Medicaid |
$368.32
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$372.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.99
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
|
FINE NDL ASPRTN PROC W/O ULT(P
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
761P2578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Ambetter Exchange |
$52.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.77
|
| Rate for Payer: Anthem Medicaid |
$65.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$190.98
|
| Rate for Payer: Healthspan PPO |
$156.33
|
| Rate for Payer: Humana Medicaid |
$65.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.69
|
| Rate for Payer: Molina Healthcare Passport |
$65.38
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.83
|
| Rate for Payer: UHCCP Medicaid |
$52.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.18
|
|
|
FINE NDL ASPRTN PROC W/O ULT(T
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
761T2578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.27 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
FINE NDL ASPRTN PROC W/O ULT(T
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
761T2578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
FINE NEEDLE ASPIRATION CT
|
Professional
|
Both
|
$1,369.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$821.40 |
| Rate for Payer: Ambetter Exchange |
$101.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.36
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$737.21
|
| Rate for Payer: Humana Medicaid |
$353.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.41
|
| Rate for Payer: Molina Healthcare Passport |
$353.34
|
| Rate for Payer: Multiplan PHCS |
$821.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.56
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.97
|
|
|
FINE NEEDLE ASPIRATION CT
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.80 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem Medicaid |
$470.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Humana KY Medicaid |
$470.80
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$475.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$480.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
FINE NEEDLE ASPIRATION CT
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.70 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
FINE NEEDLE ASPIRATION CT(P
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
761P0003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$737.21 |
| Rate for Payer: Ambetter Exchange |
$101.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.36
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$737.21
|
| Rate for Payer: Humana Medicaid |
$353.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.41
|
| Rate for Payer: Molina Healthcare Passport |
$353.34
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.56
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.97
|
|
|
FINE NEEDLE ASPIRATION CT(T
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
761T0003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.47 |
| Max. Negotiated Rate |
$1,011.84 |
| Rate for Payer: Aetna Commercial |
$811.58
|
| Rate for Payer: Anthem Medicaid |
$362.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$822.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna Commercial |
$874.82
|
| Rate for Payer: First Health Commercial |
$1,001.30
|
| Rate for Payer: Humana Commercial |
$895.90
|
| Rate for Payer: Humana KY Medicaid |
$362.47
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$366.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$864.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$369.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$927.52
|
| Rate for Payer: Ohio Health Group HMO |
$790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.26
|
| Rate for Payer: PHCS Commercial |
$1,011.84
|
| Rate for Payer: United Healthcare All Payer |
$927.52
|
|
|
FINE NEEDLE ASPIRATION CT(T
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
761T0003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$1,011.84 |
| Rate for Payer: Aetna Commercial |
$811.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$822.12
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna Commercial |
$874.82
|
| Rate for Payer: First Health Commercial |
$1,001.30
|
| Rate for Payer: Humana Commercial |
$895.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$864.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$927.52
|
| Rate for Payer: Ohio Health Group HMO |
$790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.26
|
| Rate for Payer: PHCS Commercial |
$1,011.84
|
| Rate for Payer: United Healthcare All Payer |
$927.52
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.07 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem Medicaid |
$458.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$1,105.56
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: Humana Commercial |
$1,132.20
|
| Rate for Payer: Humana KY Medicaid |
$458.07
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$462.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,092.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$467.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,172.16
|
| Rate for Payer: Ohio Health Group HMO |
$999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$919.08
|
| Rate for Payer: PHCS Commercial |
$1,278.72
|
| Rate for Payer: United Healthcare All Payer |
$1,172.16
|
|
|
FINE NEEDLE ASPIRATION US
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Ambetter Exchange |
$68.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.55
|
| Rate for Payer: Anthem Medicaid |
$98.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.54
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$203.32
|
| Rate for Payer: Humana Medicaid |
$98.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.63
|
| Rate for Payer: Molina Healthcare Passport |
$98.66
|
| Rate for Payer: Multiplan PHCS |
$799.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.41
|
| Rate for Payer: UHCCP Medicaid |
$39.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.78
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.07 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem Medicaid |
$458.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$1,105.56
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: Humana Commercial |
$1,132.20
|
| Rate for Payer: Humana KY Medicaid |
$458.07
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$462.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,092.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$467.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,172.16
|
| Rate for Payer: Ohio Health Group HMO |
$999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$919.08
|
| Rate for Payer: PHCS Commercial |
$1,278.72
|
| Rate for Payer: United Healthcare All Payer |
$1,172.16
|
|
