|
CYSTO/PYELO BX/FULG PEL LSN(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
761P2109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.28 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$652.33
|
| Rate for Payer: Anthem Medicaid |
$310.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$580.66
|
| Rate for Payer: Healthspan PPO |
$521.60
|
| Rate for Payer: Humana Medicaid |
$310.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.49
|
| Rate for Payer: Molina Healthcare Passport |
$310.28
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.38
|
|
|
CYSTO/PYELO BX/FULG PEL LSN(T
|
Facility
|
OP
|
$6,061.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
761T2109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$4,666.97
|
| Rate for Payer: Anthem Medicaid |
$2,084.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,727.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cigna Commercial |
$5,030.63
|
| Rate for Payer: First Health Commercial |
$5,757.95
|
| Rate for Payer: Humana Commercial |
$5,151.85
|
| Rate for Payer: Humana KY Medicaid |
$2,084.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,105.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,970.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,473.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,126.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,333.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,878.91
|
| Rate for Payer: PHCS Commercial |
$5,818.56
|
| Rate for Payer: United Healthcare All Payer |
$5,333.68
|
|
|
CYSTO/PYELO BX/FULG PEL LSN(T
|
Facility
|
IP
|
$6,061.00
|
|
|
Service Code
|
HCPCS 52354
|
| Hospital Charge Code |
761T2109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$5,818.56 |
| Rate for Payer: Aetna Commercial |
$4,666.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,727.58
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cigna Commercial |
$5,030.63
|
| Rate for Payer: First Health Commercial |
$5,757.95
|
| Rate for Payer: Humana Commercial |
$5,151.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,970.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,473.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,818.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,333.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,878.91
|
| Rate for Payer: PHCS Commercial |
$5,818.56
|
| Rate for Payer: United Healthcare All Payer |
$5,333.68
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Facility
|
IP
|
$6,061.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
761T2110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$5,818.56 |
| Rate for Payer: Aetna Commercial |
$4,666.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,727.58
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cigna Commercial |
$5,030.63
|
| Rate for Payer: First Health Commercial |
$5,757.95
|
| Rate for Payer: Humana Commercial |
$5,151.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,970.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,473.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,818.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,333.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,878.91
|
| Rate for Payer: PHCS Commercial |
$5,818.56
|
| Rate for Payer: United Healthcare All Payer |
$5,333.68
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Facility
|
OP
|
$7,061.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
76102110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.93 |
| Max. Negotiated Rate |
$6,778.56 |
| Rate for Payer: Aetna Commercial |
$5,436.97
|
| Rate for Payer: Anthem Medicaid |
$2,428.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,507.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$3,530.50
|
| Rate for Payer: Cash Price |
$3,530.50
|
| Rate for Payer: Cigna Commercial |
$5,860.63
|
| Rate for Payer: First Health Commercial |
$6,707.95
|
| Rate for Payer: Humana Commercial |
$6,001.85
|
| Rate for Payer: Humana KY Medicaid |
$2,428.28
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,452.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,790.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,211.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,213.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,295.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,188.91
|
| Rate for Payer: PHCS Commercial |
$6,778.56
|
| Rate for Payer: United Healthcare All Payer |
$6,213.68
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Facility
|
OP
|
$6,061.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
761T2110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$4,666.97
|
| Rate for Payer: Anthem Medicaid |
$2,084.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,727.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cash Price |
$3,030.50
|
| Rate for Payer: Cigna Commercial |
$5,030.63
|
| Rate for Payer: First Health Commercial |
$5,757.95
|
| Rate for Payer: Humana Commercial |
$5,151.85
|
| Rate for Payer: Humana KY Medicaid |
$2,084.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,105.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,970.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,473.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,126.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,333.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,878.91
|
| Rate for Payer: PHCS Commercial |
$5,818.56
|
| Rate for Payer: United Healthcare All Payer |
$5,333.68
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Professional
|
Both
|
$7,061.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
76102110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.94 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Aetna Commercial |
$778.25
|
| Rate for Payer: Anthem Medicaid |
$364.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,061.00
|
| Rate for Payer: Cash Price |
$3,530.50
|
| Rate for Payer: Cash Price |
$3,530.50
|
| Rate for Payer: Cigna Commercial |
$692.99
|
| Rate for Payer: Healthspan PPO |
$622.28
|
| Rate for Payer: Humana Medicaid |
$364.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$372.24
|
| Rate for Payer: Molina Healthcare Passport |
$364.94
|
| Rate for Payer: Multiplan PHCS |
$4,236.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,942.70
|
| Rate for Payer: UHCCP Medicaid |
$2,471.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$368.59
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Facility
|
IP
|
$7,061.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
76102110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.93 |
| Max. Negotiated Rate |
$6,778.56 |
| Rate for Payer: Aetna Commercial |
$5,436.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,507.58
|
| Rate for Payer: Cash Price |
$3,530.50
|
| Rate for Payer: Cigna Commercial |
$5,860.63
|
| Rate for Payer: First Health Commercial |
$6,707.95
|
| Rate for Payer: Humana Commercial |
$6,001.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,790.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,211.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,213.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,295.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,188.91
|
| Rate for Payer: PHCS Commercial |
$6,778.56
|
| Rate for Payer: United Healthcare All Payer |
$6,213.68
|
|
|
CYSTO/PYELOSCOPY RESCJ PEL TUM
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 52355
|
| Hospital Charge Code |
761P2110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$778.25
|
| Rate for Payer: Anthem Medicaid |
$364.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$692.99
|
| Rate for Payer: Healthspan PPO |
$622.28
|
| Rate for Payer: Humana Medicaid |
$364.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$372.24
|
| Rate for Payer: Molina Healthcare Passport |
$364.94
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$368.59
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$6,065.67
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$6,065.67 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$118.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,065.67
|
| Rate for Payer: Cash Price |
$3,032.84
|
| Rate for Payer: Cash Price |
$3,032.84
|
| Rate for Payer: Cigna Commercial |
$526.81
|
| Rate for Payer: Healthspan PPO |
$386.71
|
| Rate for Payer: Humana Medicaid |
$118.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.10
|
| Rate for Payer: Molina Healthcare Passport |
$118.73
|
| Rate for Payer: Multiplan PHCS |
$3,639.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,245.97
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.92
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,065.67
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.54 |
| Max. Negotiated Rate |
$5,823.04 |
| Rate for Payer: Aetna Commercial |
$4,670.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,731.22
|
| Rate for Payer: Cash Price |
$3,032.84
|
| Rate for Payer: Cigna Commercial |
$5,034.51
|
| Rate for Payer: First Health Commercial |
$5,762.39
|
| Rate for Payer: Humana Commercial |
$5,155.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,973.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,476.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,819.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,337.79
|
| Rate for Payer: Ohio Health Group HMO |
$4,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,880.36
|
| Rate for Payer: PHCS Commercial |
$5,823.04
|
| Rate for Payer: United Healthcare All Payer |
$5,337.79
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$915.13 |
| Max. Negotiated Rate |
$6,757.89 |
| Rate for Payer: Aetna Commercial |
$5,420.39
|
| Rate for Payer: Anthem Medicaid |
$2,420.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,490.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$5,842.76
|
| Rate for Payer: First Health Commercial |
$6,687.50
|
| Rate for Payer: Humana Commercial |
$5,983.55
|
| Rate for Payer: Humana KY Medicaid |
$2,420.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,194.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.24
|
| Rate for Payer: PHCS Commercial |
$6,757.89
|
| Rate for Payer: United Healthcare All Payer |
$6,194.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$915.13 |
| Max. Negotiated Rate |
$6,757.89 |
| Rate for Payer: Aetna Commercial |
$5,420.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,490.79
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$5,842.76
|
| Rate for Payer: First Health Commercial |
$6,687.50
|
| Rate for Payer: Humana Commercial |
$5,983.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,194.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.24
|
| Rate for Payer: PHCS Commercial |
$6,757.89
|
| Rate for Payer: United Healthcare All Payer |
$6,194.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$6,065.67
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.54 |
| Max. Negotiated Rate |
$5,823.04 |
| Rate for Payer: Aetna Commercial |
$4,670.57
|
| Rate for Payer: Anthem Medicaid |
$2,085.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,731.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,032.84
|
| Rate for Payer: Cash Price |
$3,032.84
|
| Rate for Payer: Cigna Commercial |
$5,034.51
|
| Rate for Payer: First Health Commercial |
$5,762.39
|
| Rate for Payer: Humana Commercial |
$5,155.82
|
| Rate for Payer: Humana KY Medicaid |
$2,085.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,107.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,973.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,476.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,127.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,337.79
|
| Rate for Payer: Ohio Health Group HMO |
$4,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,880.36
|
| Rate for Payer: PHCS Commercial |
$5,823.04
|
| Rate for Payer: United Healthcare All Payer |
$5,337.79
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.10 |
| Max. Negotiated Rate |
$7,039.47 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Anthem Medicaid |
$249.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,039.47
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$393.02
|
| Rate for Payer: Healthspan PPO |
$353.41
|
| Rate for Payer: Humana Medicaid |
$249.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.08
|
| Rate for Payer: Molina Healthcare Passport |
$249.10
|
| Rate for Payer: Multiplan PHCS |
$4,223.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,927.63
|
| Rate for Payer: UHCCP Medicaid |
$2,463.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.59
|
|
|
CYSTOSCOPY AND TREATMENT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761P2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.10 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Anthem Medicaid |
$249.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$393.02
|
| Rate for Payer: Healthspan PPO |
$353.41
|
| Rate for Payer: Humana Medicaid |
$249.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.08
|
| Rate for Payer: Molina Healthcare Passport |
$249.10
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.59
|
|
|
CYSTOSCOPY AND TREATMENT(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761P2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$118.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$526.81
|
| Rate for Payer: Healthspan PPO |
$386.71
|
| Rate for Payer: Humana Medicaid |
$118.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.10
|
| Rate for Payer: Molina Healthcare Passport |
$118.73
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.92
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
IP
|
$5,739.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761T2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.13 |
| Max. Negotiated Rate |
$5,509.89 |
| Rate for Payer: Aetna Commercial |
$4,419.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,476.79
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cigna Commercial |
$4,763.76
|
| Rate for Payer: First Health Commercial |
$5,452.50
|
| Rate for Payer: Humana Commercial |
$4,878.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,706.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,235.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,721.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,050.73
|
| Rate for Payer: Ohio Health Group HMO |
$4,304.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,147.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,779.24
|
| Rate for Payer: PHCS Commercial |
$5,509.89
|
| Rate for Payer: United Healthcare All Payer |
$5,050.73
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
OP
|
$5,115.67
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761T2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.04 |
| Max. Negotiated Rate |
$4,911.04 |
| Rate for Payer: Aetna Commercial |
$3,939.07
|
| Rate for Payer: Anthem Medicaid |
$1,759.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,557.84
|
| Rate for Payer: Cash Price |
$2,557.84
|
| Rate for Payer: Cigna Commercial |
$4,246.01
|
| Rate for Payer: First Health Commercial |
$4,859.89
|
| Rate for Payer: Humana Commercial |
$4,348.32
|
| Rate for Payer: Humana KY Medicaid |
$1,759.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,777.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,194.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,501.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,836.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,585.86
|
| Rate for Payer: PHCS Commercial |
$4,911.04
|
| Rate for Payer: United Healthcare All Payer |
$4,501.79
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
OP
|
$5,739.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761T2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.13 |
| Max. Negotiated Rate |
$5,509.89 |
| Rate for Payer: Aetna Commercial |
$4,419.39
|
| Rate for Payer: Anthem Medicaid |
$1,973.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,476.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cigna Commercial |
$4,763.76
|
| Rate for Payer: First Health Commercial |
$5,452.50
|
| Rate for Payer: Humana Commercial |
$4,878.55
|
| Rate for Payer: Humana KY Medicaid |
$1,973.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,993.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,706.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,235.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,050.73
|
| Rate for Payer: Ohio Health Group HMO |
$4,304.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,147.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,779.24
|
| Rate for Payer: PHCS Commercial |
$5,509.89
|
| Rate for Payer: United Healthcare All Payer |
$5,050.73
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
IP
|
$5,115.67
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761T2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.04 |
| Max. Negotiated Rate |
$4,911.04 |
| Rate for Payer: Aetna Commercial |
$3,939.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.22
|
| Rate for Payer: Cash Price |
$2,557.84
|
| Rate for Payer: Cigna Commercial |
$4,246.01
|
| Rate for Payer: First Health Commercial |
$4,859.89
|
| Rate for Payer: Humana Commercial |
$4,348.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,194.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,501.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,836.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,585.86
|
| Rate for Payer: PHCS Commercial |
$4,911.04
|
| Rate for Payer: United Healthcare All Payer |
$4,501.79
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$5,340.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$5,126.40 |
| Rate for Payer: Aetna Commercial |
$4,111.80
|
| Rate for Payer: Anthem Medicaid |
$1,836.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,165.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cigna Commercial |
$4,432.20
|
| Rate for Payer: First Health Commercial |
$5,073.00
|
| Rate for Payer: Humana Commercial |
$4,539.00
|
| Rate for Payer: Humana KY Medicaid |
$1,836.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,855.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,378.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,940.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,873.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,655.40
|
| Rate for Payer: PHCS Commercial |
$5,126.40
|
| Rate for Payer: United Healthcare All Payer |
$4,699.20
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$5,340.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.18
|
| Rate for Payer: Anthem Medicaid |
$134.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,340.00
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cigna Commercial |
$512.83
|
| Rate for Payer: Healthspan PPO |
$282.30
|
| Rate for Payer: Humana Medicaid |
$134.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.66
|
| Rate for Payer: Molina Healthcare Passport |
$134.96
|
| Rate for Payer: Multiplan PHCS |
$3,204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,738.00
|
| Rate for Payer: UHCCP Medicaid |
$109.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.31
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$5,340.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$5,126.40 |
| Rate for Payer: Aetna Commercial |
$4,111.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,165.20
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cigna Commercial |
$4,432.20
|
| Rate for Payer: First Health Commercial |
$5,073.00
|
| Rate for Payer: Humana Commercial |
$4,539.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,378.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,940.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,655.40
|
| Rate for Payer: PHCS Commercial |
$5,126.40
|
| Rate for Payer: United Healthcare All Payer |
$4,699.20
|
|
|
CYSTOSCOPY CHEMODENERVATION (P
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761P2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$512.83 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.18
|
| Rate for Payer: Anthem Medicaid |
$134.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$410.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$512.83
|
| Rate for Payer: Healthspan PPO |
$282.30
|
| Rate for Payer: Humana Medicaid |
$134.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.66
|
| Rate for Payer: Molina Healthcare Passport |
$134.96
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.00
|
| Rate for Payer: UHCCP Medicaid |
$109.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.31
|
|
