|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
30001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.71
|
| 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 |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| 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 |
$141.00 |
| Rate for Payer: Aetna Commercial |
$78.81
|
| Rate for Payer: Ambetter Exchange |
$75.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.28
|
| 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: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.23
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.80
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.23
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
30001579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| 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 |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| 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 |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| 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 |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CYTOPLASMICNTRPHL AB ANCAPANCA
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
30001019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| 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 |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
CYTOPLASMICNTRPHL AB ANCAPANCA
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
30001019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
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 |
$10.37 |
| 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 |
$10.37
|
| 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 |
$27.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.84
|
| Rate for Payer: PHCS Commercial |
$33.17
|
| Rate for Payer: United Healthcare All Payer |
$30.40
|
|
|
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 |
$10.37 |
| 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 |
$10.37
|
| 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 |
$27.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.84
|
| 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 |
$27.00 |
| 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 |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| 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 |
$98.57 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Ambetter Exchange |
$75.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.98
|
| 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: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.82
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.57
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.82
|
|
|
CYTOSMEARS BILL SURG TCH PREP
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30001420
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| 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 |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| 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 |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| 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 |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
CYTOSMEARS SURG TCH PREP
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30002038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| 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 |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| 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 |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| 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 |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.53
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
CYTOSMEARS SURG TCH PREP
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
30002038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.10 |
| 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 |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.53
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
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 |
$98.57 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Ambetter Exchange |
$75.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.98
|
| 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: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.82
|
| Rate for Payer: Multiplan PHCS |
$82.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.57
|
| Rate for Payer: UHCCP Medicaid |
$47.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.82
|
|
|
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 |
$98.57 |
| Rate for Payer: Aetna Commercial |
$82.03
|
| Rate for Payer: Ambetter Exchange |
$75.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.98
|
| 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: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.82
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.57
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.82
|
|
|
CYTOSMEARS SURG TCH PREP (T
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
300T2038
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| 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 |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| 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 |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| 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 |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| 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 |
$26.10 |
| 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 |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
CYTOTEC (MISOPROST 100MCG/1TAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 70954044320
|
| Hospital Charge Code |
25000508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
CYTOTEC (MISOPROST 100MCG/1TAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 70954044320
|
| Hospital Charge Code |
25000508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.67 |
| 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
|
| 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 |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
CYTOTEC (MISOPROST 200MCG/TAB)
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
25000509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
CYTOTEC (MISOPROST 200MCG/TAB)
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
25000509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
CYTOVENE (GANCICLOV 500MG/10ML
|
Facility
|
IP
|
$366.27
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
25002978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.88 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$282.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.69
|
| Rate for Payer: Cash Price |
$183.14
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: First Health Commercial |
$347.96
|
| Rate for Payer: Humana Commercial |
$311.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.32
|
| Rate for Payer: Ohio Health Group HMO |
$274.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.73
|
| Rate for Payer: PHCS Commercial |
$351.62
|
| Rate for Payer: United Healthcare All Payer |
$322.32
|
|
|
CYTOVENE (GANCICLOV 500MG/10ML
|
Facility
|
OP
|
$366.27
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
25002978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.88 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$282.03
|
| Rate for Payer: Anthem Medicaid |
$125.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.69
|
| Rate for Payer: Cash Price |
$183.14
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: First Health Commercial |
$347.96
|
| Rate for Payer: Humana Commercial |
$311.33
|
| Rate for Payer: Humana KY Medicaid |
$125.96
|
| Rate for Payer: Kentucky WC Medicaid |
$127.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.32
|
| Rate for Payer: Ohio Health Group HMO |
$274.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.73
|
| Rate for Payer: PHCS Commercial |
$351.62
|
| Rate for Payer: United Healthcare All Payer |
$322.32
|
|
|
CYTOXAN(CYCLOPHOSPHA 50MG/1TAB
|
Facility
|
OP
|
$74.94
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
25002535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$71.94 |
| Rate for Payer: Aetna Commercial |
$57.70
|
| Rate for Payer: Anthem Medicaid |
$25.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.45
|
| Rate for Payer: Cash Price |
$37.47
|
| Rate for Payer: Cigna Commercial |
$62.20
|
| Rate for Payer: First Health Commercial |
$71.19
|
| Rate for Payer: Humana Commercial |
$63.70
|
| Rate for Payer: Humana KY Medicaid |
$25.77
|
| Rate for Payer: Kentucky WC Medicaid |
$26.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.95
|
| Rate for Payer: Ohio Health Group HMO |
$56.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.71
|
| Rate for Payer: PHCS Commercial |
$71.94
|
| Rate for Payer: United Healthcare All Payer |
$65.95
|
|
|
CYTOXAN(CYCLOPHOSPHA 50MG/1TAB
|
Facility
|
IP
|
$74.94
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
25002535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$71.94 |
| Rate for Payer: Aetna Commercial |
$57.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.45
|
| Rate for Payer: Cash Price |
$37.47
|
| Rate for Payer: Cigna Commercial |
$62.20
|
| Rate for Payer: First Health Commercial |
$71.19
|
| Rate for Payer: Humana Commercial |
$63.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.95
|
| Rate for Payer: Ohio Health Group HMO |
$56.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.71
|
| Rate for Payer: PHCS Commercial |
$71.94
|
| Rate for Payer: United Healthcare All Payer |
$65.95
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
30001423
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Aetna Commercial |
$80.30
|
| Rate for Payer: Ambetter Exchange |
$51.87
|
| Rate for Payer: Anthem Medicaid |
$44.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.24
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$33.06
|
| Rate for Payer: Healthspan PPO |
$76.24
|
| Rate for Payer: Humana Medicaid |
$44.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Healthcare Passport |
$44.34
|
| Rate for Payer: Multiplan PHCS |
$150.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.43
|
| Rate for Payer: UHCCP Medicaid |
$87.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.87
|
|
