|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
OP
|
$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 Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$475.00
|
| 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: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| 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 |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| 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
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T2850
|
|
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 Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$475.00
|
| 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: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| 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 |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| 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
|
|
|
FINE NEEDLE ASPIRATION US(T
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
761T2850
|
|
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
|
|
|
FINE NEEDLE ASP US GUID
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,397.00
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cash Price |
$698.50
|
| 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: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$838.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.90
|
| Rate for Payer: UHCCP Medicaid |
$488.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
FINE NEEDLE ASP US GUID
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
FINE NEEDLE ASP US GUID
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
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: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| 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: 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 |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
FINE NEEDLE ASP US GUID(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
FINE NEEDLE ASP US GUID(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
FINERENONE 10 MG TABLET
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$35.92 |
| Rate for Payer: Buckeye Medicare Advantage |
$35.92
|
| 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
|
IP
|
$35.92
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$4.67 |
| 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 |
$7.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.14
|
| 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 |
$35.92 |
| Rate for Payer: Buckeye Medicare Advantage |
$35.92
|
| 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
|
|
|
FINGER LT: ROUTINE MIN 2V
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
FINGER LT: ROUTINE MIN 2V
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
FINGER LT: ROUTINE MIN 2V
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna Commercial |
$42.82
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$39.27
|
| Rate for Payer: Healthspan PPO |
$40.12
|
| Rate for Payer: Humana Medicaid |
$17.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare Passport |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$241.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.40
|
| Rate for Payer: UHCCP Medicaid |
$140.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.29
|
|
|
FINGER LT: ROUTINE MIN 2V(P
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
320P0089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Aetna Commercial |
$42.82
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$39.27
|
| Rate for Payer: Healthspan PPO |
$40.12
|
| Rate for Payer: Humana Medicaid |
$17.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare Passport |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.29
|
|
|
FINGER LT: ROUTINE MIN 2V(T
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
320T0089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem Medicaid |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Humana KY Medicaid |
$126.21
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
FINGER LT: ROUTINE MIN 2V(T
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
320T0089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
