|
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
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| 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: 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 |
$399.60
|
| 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
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| 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: 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 |
$399.60
|
| 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(P
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761P2850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$203.32 |
| 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 |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| 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 |
$192.00
|
| 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(P
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761P0001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$203.32 |
| 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 |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| 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 |
$192.00
|
| 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(T
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T2850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$971.52 |
| Rate for Payer: Aetna Commercial |
$779.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$789.36
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: First Health Commercial |
$961.40
|
| Rate for Payer: Humana Commercial |
$860.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$829.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$746.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$890.56
|
| Rate for Payer: Ohio Health Group HMO |
$759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$698.28
|
| Rate for Payer: PHCS Commercial |
$971.52
|
| Rate for Payer: United Healthcare All Payer |
$890.56
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T0001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$971.52 |
| Rate for Payer: Aetna Commercial |
$779.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$789.36
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: First Health Commercial |
$961.40
|
| Rate for Payer: Humana Commercial |
$860.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$829.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$746.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$890.56
|
| Rate for Payer: Ohio Health Group HMO |
$759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$698.28
|
| Rate for Payer: PHCS Commercial |
$971.52
|
| Rate for Payer: United Healthcare All Payer |
$890.56
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T2850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.03 |
| Max. Negotiated Rate |
$971.52 |
| Rate for Payer: Aetna Commercial |
$779.24
|
| Rate for Payer: Anthem Medicaid |
$348.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$789.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: First Health Commercial |
$961.40
|
| Rate for Payer: Humana Commercial |
$860.20
|
| Rate for Payer: Humana KY Medicaid |
$348.03
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$351.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$829.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$746.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$890.56
|
| Rate for Payer: Ohio Health Group HMO |
$759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$698.28
|
| Rate for Payer: PHCS Commercial |
$971.52
|
| Rate for Payer: United Healthcare All Payer |
$890.56
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T0001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.03 |
| Max. Negotiated Rate |
$971.52 |
| Rate for Payer: Aetna Commercial |
$779.24
|
| Rate for Payer: Anthem Medicaid |
$348.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$789.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: First Health Commercial |
$961.40
|
| Rate for Payer: Humana Commercial |
$860.20
|
| Rate for Payer: Humana KY Medicaid |
$348.03
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$351.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$829.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$746.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$890.56
|
| Rate for Payer: Ohio Health Group HMO |
$759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$698.28
|
| Rate for Payer: PHCS Commercial |
$971.52
|
| Rate for Payer: United Healthcare All Payer |
$890.56
|
|
|
FINE NEEDLE ASP US GUID
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
FINE NEEDLE ASP US GUID
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
FINE NEEDLE ASP US GUID
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
FINE NEEDLE ASP US GUID(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
FINE NEEDLE ASP US GUID(T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
FINE NEEDLE ASP US GUID(T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
FINERENONE 10 MG TABLET
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 10 MG TABLET
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
636T0211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem Medicaid |
$12.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Humana KY Medicaid |
$12.35
|
| Rate for Payer: Kentucky WC Medicaid |
$12.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 10 MG TABLET
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
636T0211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 10 MG TABLET
|
Professional
|
Both
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$21.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$25.14
|
| Rate for Payer: UHCCP Medicaid |
$12.57
|
|
|
FINERENONE 10 MG TABLET
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem Medicaid |
$12.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Humana KY Medicaid |
$12.35
|
| Rate for Payer: Kentucky WC Medicaid |
$12.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 20 MG TABLET
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 20 MG TABLET
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem Medicaid |
$12.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Humana KY Medicaid |
$12.35
|
| Rate for Payer: Kentucky WC Medicaid |
$12.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 20 MG TABLET
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
636T0212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 20 MG TABLET
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
636T0212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Anthem Medicaid |
$12.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cigna Commercial |
$29.81
|
| Rate for Payer: First Health Commercial |
$34.12
|
| Rate for Payer: Humana Commercial |
$30.53
|
| Rate for Payer: Humana KY Medicaid |
$12.35
|
| Rate for Payer: Kentucky WC Medicaid |
$12.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.61
|
| Rate for Payer: Ohio Health Group HMO |
$26.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$34.48
|
| Rate for Payer: United Healthcare All Payer |
$31.61
|
|
|
FINERENONE 20 MG TABLET
|
Professional
|
Both
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$21.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$25.14
|
| Rate for Payer: UHCCP Medicaid |
$12.57
|
|
