|
FILTER WIRE EZ 300CM
|
Facility
|
IP
|
$6,918.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$899.46 |
| Max. Negotiated Rate |
$6,642.16 |
| Rate for Payer: Aetna Commercial |
$5,327.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.76
|
| Rate for Payer: Cash Price |
$3,459.46
|
| Rate for Payer: Cigna Commercial |
$5,742.70
|
| Rate for Payer: First Health Commercial |
$6,572.97
|
| Rate for Payer: Humana Commercial |
$5,881.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.87
|
| Rate for Payer: PHCS Commercial |
$6,642.16
|
| Rate for Payer: United Healthcare All Payer |
$6,088.65
|
|
|
FILTER WIRE EZ 300CM
|
Facility
|
OP
|
$6,918.92
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$899.46 |
| Max. Negotiated Rate |
$6,642.16 |
| Rate for Payer: Aetna Commercial |
$5,327.57
|
| Rate for Payer: Anthem Medicaid |
$2,379.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.76
|
| Rate for Payer: Cash Price |
$3,459.46
|
| Rate for Payer: Cigna Commercial |
$5,742.70
|
| Rate for Payer: First Health Commercial |
$6,572.97
|
| Rate for Payer: Humana Commercial |
$5,881.08
|
| Rate for Payer: Humana KY Medicaid |
$2,379.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,403.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,427.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.87
|
| Rate for Payer: PHCS Commercial |
$6,642.16
|
| Rate for Payer: United Healthcare All Payer |
$6,088.65
|
|
|
FINE CROSS MG 150CM
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
FINE CROSS MG 150CM
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| 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 Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| 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: Molina Healthcare CHIP/Medicaid |
$66.69
|
| Rate for Payer: Molina Healthcare Passport |
$65.38
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$52.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.03
|
|
|
FINE NDL ASPRTN PROC W/O ULT
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
76102578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
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 |
$320.00 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| 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 Medicare Advantage |
$320.00
|
| 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: 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 |
$224.00
|
| Rate for Payer: UHCCP Medicaid |
$52.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.03
|
|
|
FINE NDL ASPRTN PROC W/O ULT(T
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
761T2578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.55
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
FINE NDL ASPRTN PROC W/O ULT(T
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
761T2578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.55
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
FINE NEEDLE ASPIRATION CT
|
Facility
|
IP
|
$1,333.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.29 |
| Max. Negotiated Rate |
$1,279.68 |
| Rate for Payer: Aetna Commercial |
$1,026.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,039.74
|
| Rate for Payer: Cash Price |
$666.50
|
| Rate for Payer: Cigna Commercial |
$1,106.39
|
| Rate for Payer: First Health Commercial |
$1,266.35
|
| Rate for Payer: Humana Commercial |
$1,133.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,093.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,173.04
|
| Rate for Payer: Ohio Health Group HMO |
$999.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.23
|
| Rate for Payer: PHCS Commercial |
$1,279.68
|
| Rate for Payer: United Healthcare All Payer |
$1,173.04
|
|
|
FINE NEEDLE ASPIRATION CT
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$1,333.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,333.00
|
| Rate for Payer: Cash Price |
$666.50
|
| Rate for Payer: Cash Price |
$666.50
|
| Rate for Payer: Cigna Commercial |
$737.21
|
| Rate for Payer: Humana Medicaid |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$799.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$933.10
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
|
|
FINE NEEDLE ASPIRATION CT
|
Facility
|
OP
|
$1,333.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.29 |
| Max. Negotiated Rate |
$1,279.68 |
| Rate for Payer: Aetna Commercial |
$1,026.41
|
| Rate for Payer: Anthem Medicaid |
$458.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,039.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$666.50
|
| Rate for Payer: Cash Price |
$666.50
|
| Rate for Payer: Cigna Commercial |
$1,106.39
|
| Rate for Payer: First Health Commercial |
$1,266.35
|
| Rate for Payer: Humana Commercial |
$1,133.05
|
| Rate for Payer: Humana KY Medicaid |
$458.42
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$463.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,093.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$467.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,173.04
|
| Rate for Payer: Ohio Health Group HMO |
$999.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.23
|
| Rate for Payer: PHCS Commercial |
$1,279.68
|
| Rate for Payer: United Healthcare All Payer |
$1,173.04
|
|
|
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: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| 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 |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
|
|
FINE NEEDLE ASPIRATION CT(T
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
761T0003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.34 |
| Max. Negotiated Rate |
$977.28 |
| Rate for Payer: Aetna Commercial |
$783.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.04
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$844.94
|
| Rate for Payer: First Health Commercial |
$967.10
|
| Rate for Payer: Humana Commercial |
$865.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.84
|
| Rate for Payer: Ohio Health Group HMO |
$763.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.58
|
| Rate for Payer: PHCS Commercial |
$977.28
|
| Rate for Payer: United Healthcare All Payer |
$895.84
|
|
|
FINE NEEDLE ASPIRATION CT(T
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
761T0003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.34 |
| Max. Negotiated Rate |
$977.28 |
| Rate for Payer: Aetna Commercial |
$783.86
|
| Rate for Payer: Anthem Medicaid |
$350.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$844.94
|
| Rate for Payer: First Health Commercial |
$967.10
|
| Rate for Payer: Humana Commercial |
$865.30
|
| Rate for Payer: Humana KY Medicaid |
$350.09
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$353.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$357.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.84
|
| Rate for Payer: Ohio Health Group HMO |
$763.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.58
|
| Rate for Payer: PHCS Commercial |
$977.28
|
| Rate for Payer: United Healthcare All Payer |
$895.84
|
|
|
FINE NEEDLE ASPIRATION US
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.55
|
| Rate for Payer: Anthem Medicaid |
$59.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$203.32
|
| Rate for Payer: Humana Medicaid |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.96
|
| Rate for Payer: Molina Healthcare Passport |
$59.76
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$39.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.36
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76102850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
FINE NEEDLE ASPIRATION US
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.55
|
| Rate for Payer: Anthem Medicaid |
$59.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$203.32
|
| Rate for Payer: Humana Medicaid |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.96
|
| Rate for Payer: Molina Healthcare Passport |
$59.76
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$39.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.36
|
|
|
FINE NEEDLE ASPIRATION US
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
76100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
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 |
$320.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.55
|
| Rate for Payer: Anthem Medicaid |
$59.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$320.00
|
| 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 |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.96
|
| Rate for Payer: Molina Healthcare Passport |
$59.76
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.00
|
| Rate for Payer: UHCCP Medicaid |
$39.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.36
|
|
|
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 |
$320.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.55
|
| Rate for Payer: Anthem Medicaid |
$59.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$320.00
|
| 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 |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.96
|
| Rate for Payer: Molina Healthcare Passport |
$59.76
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.00
|
| Rate for Payer: UHCCP Medicaid |
$39.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.36
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T0001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
