|
CYTOMEL(LIOTHYRONI) 5 MCG TAB
|
Facility
|
OP
|
$9.06
|
|
|
Service Code
|
NDC 51862032001
|
| Hospital Charge Code |
25000506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem Medicaid |
$3.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.52
|
| Rate for Payer: First Health Commercial |
$8.61
|
| Rate for Payer: Humana Commercial |
$7.70
|
| Rate for Payer: Humana KY Medicaid |
$3.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.97
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Payer |
$7.97
|
|
|
CYTOMEL(LIOTHYRONINESOD)25MGT
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 62756059088
|
| Hospital Charge Code |
25000507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
|
|
CYTOMEL(LIOTHYRONINESOD)25MGT
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 62756059088
|
| Hospital Charge Code |
25000507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
300T2039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$234.24 |
| Rate for Payer: Aetna Commercial |
$187.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.93
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$202.52
|
| Rate for Payer: First Health Commercial |
$231.80
|
| Rate for Payer: Humana Commercial |
$207.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$214.72
|
| Rate for Payer: Ohio Health Group HMO |
$183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.64
|
| Rate for Payer: PHCS Commercial |
$234.24
|
| Rate for Payer: United Healthcare All Payer |
$214.72
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001419
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$155.01
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Healthspan PPO |
$147.18
|
| Rate for Payer: Humana Medicaid |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.40
|
| Rate for Payer: Molina Healthcare Passport |
$87.65
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.59
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30002039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$87.65
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$88.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30002039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$155.01
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Healthspan PPO |
$147.18
|
| Rate for Payer: Humana Medicaid |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.40
|
| Rate for Payer: Molina Healthcare Passport |
$87.65
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.59
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001419
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
300T2039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$234.24 |
| Rate for Payer: Aetna Commercial |
$187.88
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$202.52
|
| Rate for Payer: First Health Commercial |
$231.80
|
| Rate for Payer: Humana Commercial |
$207.40
|
| Rate for Payer: Humana KY Medicaid |
$87.65
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$88.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$214.72
|
| Rate for Payer: Ohio Health Group HMO |
$183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.64
|
| Rate for Payer: PHCS Commercial |
$234.24
|
| Rate for Payer: United Healthcare All Payer |
$214.72
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001419
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$87.65
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$88.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30002039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.87
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
CYTOPATH CELL ENHANCE TECH (P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
300P2039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$155.01 |
| Rate for Payer: Aetna Commercial |
$155.01
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Healthspan PPO |
$147.18
|
| Rate for Payer: Humana Medicaid |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.40
|
| Rate for Payer: Molina Healthcare Passport |
$87.65
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.59
|
|
|
CYTOPATH C/V AUTO FLUID REDO
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001426
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$195.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.96
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cigna Commercial |
$210.82
|
| Rate for Payer: First Health Commercial |
$241.30
|
| Rate for Payer: Humana Commercial |
$215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$208.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$187.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$223.52
|
| Rate for Payer: Ohio Health Group HMO |
$190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.74
|
| Rate for Payer: PHCS Commercial |
$243.84
|
| Rate for Payer: United Healthcare All Payer |
$223.52
|
|
|
CYTOPATH C/V AUTO FLUID REDO
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001426
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$195.58
|
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.61
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cash Price |
$127.00
|
| Rate for Payer: Cigna Commercial |
$210.82
|
| Rate for Payer: First Health Commercial |
$241.30
|
| Rate for Payer: Humana Commercial |
$215.90
|
| Rate for Payer: Humana KY Medicaid |
$26.61
|
| Rate for Payer: Humana Medicare Advantage |
$26.61
|
| Rate for Payer: Kentucky WC Medicaid |
$26.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$208.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$187.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$223.52
|
| Rate for Payer: Ohio Health Group HMO |
$190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.74
|
| Rate for Payer: PHCS Commercial |
$243.84
|
| Rate for Payer: United Healthcare All Payer |
$223.52
|
|
|
CYTOPATH C/V AUTO IN FLUID
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 88174
|
| Hospital Charge Code |
30001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH C/V AUTO IN FLUID
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 88174
|
| Hospital Charge Code |
30001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$18.94
|
| Rate for Payer: Healthspan PPO |
$36.00
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.22
|
|
|
CYTOPATH C/V AUTO IN FLUID
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 88174
|
| Hospital Charge Code |
30001580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$25.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.37
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$25.37
|
| Rate for Payer: Humana Medicare Advantage |
$25.37
|
| Rate for Payer: Kentucky WC Medicaid |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH C/V INTERPRET
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
30001578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$18.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$18.02
|
| Rate for Payer: Kentucky WC Medicaid |
$18.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH C/V INTERPRET
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
30001578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$42.26
|
| Rate for Payer: Anthem Medicaid |
$18.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$15.28
|
| Rate for Payer: Healthspan PPO |
$40.13
|
| Rate for Payer: Humana Medicaid |
$18.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.38
|
| Rate for Payer: Molina Healthcare Passport |
$18.02
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.81
|
|
|
CYTOPATH C/V INTERPRET
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
30001578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CYTOPATH EVAL FNA REPORT
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
30001424
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$231.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
CYTOPATH EVAL FNA REPORT
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
30001424
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$202.44
|
| Rate for Payer: Anthem Medicaid |
$97.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$86.08
|
| Rate for Payer: Healthspan PPO |
$192.22
|
| Rate for Payer: Humana Medicaid |
$97.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.07
|
| Rate for Payer: Molina Healthcare Passport |
$97.13
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$100.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.10
|
|
|
CYTOPATH EVAL FNA REPORT
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
30001424
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$231.26
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
CYTOPATH FL NONGYN SMEARS
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
30002032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$36.12
|
| Rate for Payer: Healthspan PPO |
$88.28
|
| Rate for Payer: Humana Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.15
|
| Rate for Payer: Molina Healthcare Passport |
$35.44
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.26
|
|
|
CYTOPATH FL NONGYN SMEARS
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
30001416
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$36.12
|
| Rate for Payer: Healthspan PPO |
$88.28
|
| Rate for Payer: Humana Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.15
|
| Rate for Payer: Molina Healthcare Passport |
$35.44
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.26
|
|
