|
CYTOPATH FL NONGYN SMEARS
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
30001416
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
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
|
|
|
CYTOPATH FL NONGYN SMEARS
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
30002032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$35.44
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$35.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
CYTOPATH FL NONGYN SMEARS
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
30001416
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$35.44
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$35.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
CYTOPATH FL NONGYN SMEARS (P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
300P2032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$92.98 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| 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 |
$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 |
$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 |
$21.26
|
|
|
CYTOPATH FL NONGYN SMEARS (T
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
300T2032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem Medicaid |
$35.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Humana KY Medicaid |
$35.44
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$35.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
CYTOPATH FL NONGYN SMEARS (T
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
300T2032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
30001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
30001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$36.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$36.56
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$36.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
30001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$78.81
|
| Rate for Payer: Anthem Medicaid |
$36.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$32.92
|
| Rate for Payer: Healthspan PPO |
$74.83
|
| Rate for Payer: Humana Medicaid |
$36.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.29
|
| Rate for Payer: Molina Healthcare Passport |
$36.56
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.94
|
|
|
CYTOPLASMICNTRPHL AB ANCAPANCA
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
30001019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CYTOPLASMICNTRPHL AB ANCAPANCA
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
30001019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CYTOSAR U(CYTARABINE) 100 MG C
|
Facility
|
OP
|
$34.55
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
25002592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$33.17 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Anthem Medicaid |
$11.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.95
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna Commercial |
$28.68
|
| Rate for Payer: First Health Commercial |
$32.82
|
| Rate for Payer: Humana Commercial |
$29.37
|
| Rate for Payer: Humana KY Medicaid |
$11.88
|
| Rate for Payer: Kentucky WC Medicaid |
$12.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.40
|
| Rate for Payer: Ohio Health Group HMO |
$25.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.71
|
| Rate for Payer: PHCS Commercial |
$33.17
|
| Rate for Payer: United Healthcare All Payer |
$30.40
|
|
|
CYTOSAR U(CYTARABINE) 100 MG C
|
Facility
|
IP
|
$34.55
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
25002592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$33.17 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.95
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna Commercial |
$28.68
|
| Rate for Payer: First Health Commercial |
$32.82
|
| Rate for Payer: Humana Commercial |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.40
|
| Rate for Payer: Ohio Health Group HMO |
$25.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.71
|
| Rate for Payer: PHCS Commercial |
$33.17
|
| Rate for Payer: United Healthcare All Payer |
$30.40
|
|
|
CYTOSMEARS BILL SURG TCH PREP
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30001420
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
CYTOSMEARS BILL SURG TCH PREP
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30001420
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$36.27
|
| Rate for Payer: Healthspan PPO |
$77.88
|
| Rate for Payer: Humana Medicaid |
$36.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.55
|
| Rate for Payer: Molina Healthcare Passport |
$36.81
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.09
|
|
|
CYTOSMEARS BILL SURG TCH PREP
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30001420
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$36.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
CYTOSMEARS SURG TCH PREP
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30002038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$36.27
|
| Rate for Payer: Healthspan PPO |
$77.88
|
| Rate for Payer: Humana Medicaid |
$36.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.55
|
| Rate for Payer: Molina Healthcare Passport |
$36.81
|
| Rate for Payer: Multiplan PHCS |
$82.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.90
|
| Rate for Payer: UHCCP Medicaid |
$47.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.09
|
|
|
CYTOSMEARS SURG TCH PREP
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30002038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
CYTOSMEARS SURG TCH PREP
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30002038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$36.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
CYTOSMEARS SURG TCH PREP (P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
300P2038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$82.03 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| 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 |
$36.27
|
| Rate for Payer: Healthspan PPO |
$77.88
|
| Rate for Payer: Humana Medicaid |
$36.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.55
|
| Rate for Payer: Molina Healthcare Passport |
$36.81
|
| 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 |
$22.09
|
|
|
CYTOSMEARS SURG TCH PREP (T
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
300T2038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$36.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$36.81
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
CYTOSMEARS SURG TCH PREP (T
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
300T2038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.97
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
CYTOTEC (MISOPROST 100MCG/1TAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 70954044320
|
| Hospital Charge Code |
25000508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
|
|
CYTOTEC (MISOPROST 100MCG/1TAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 70954044320
|
| Hospital Charge Code |
25000508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
