|
CYSTOSCOPY CHEMODENERVATION (T
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761T2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
CYSTOSCOPY CHEMODENERVATION (T
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761T2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| 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 |
$2,465.00
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
OP
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$843.70 |
| Max. Negotiated Rate |
$6,230.40 |
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Anthem Medicaid |
$2,231.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$5,386.70
|
| Rate for Payer: First Health Commercial |
$6,165.50
|
| Rate for Payer: Humana Commercial |
$5,516.50
|
| Rate for Payer: Humana KY Medicaid |
$2,231.91
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,254.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,276.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.90
|
| Rate for Payer: PHCS Commercial |
$6,230.40
|
| Rate for Payer: United Healthcare All Payer |
$5,711.20
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
IP
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$843.70 |
| Max. Negotiated Rate |
$6,230.40 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.20
|
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$5,386.70
|
| Rate for Payer: First Health Commercial |
$6,165.50
|
| Rate for Payer: Humana Commercial |
$5,516.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.90
|
| Rate for Payer: PHCS Commercial |
$6,230.40
|
| Rate for Payer: United Healthcare All Payer |
$5,711.20
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Professional
|
Both
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.59 |
| Max. Negotiated Rate |
$6,490.00 |
| Rate for Payer: Aetna Commercial |
$557.76
|
| Rate for Payer: Anthem Medicaid |
$313.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,490.00
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$499.55
|
| Rate for Payer: Healthspan PPO |
$445.98
|
| Rate for Payer: Humana Medicaid |
$313.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.86
|
| Rate for Payer: Molina Healthcare Passport |
$313.59
|
| Rate for Payer: Multiplan PHCS |
$3,894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,543.00
|
| Rate for Payer: UHCCP Medicaid |
$2,271.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$316.73
|
|
|
CYSTOSCOPY IMPLANT STENT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761P2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.59 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$557.76
|
| Rate for Payer: Anthem Medicaid |
$313.59
|
| 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 |
$499.55
|
| Rate for Payer: Healthspan PPO |
$445.98
|
| Rate for Payer: Humana Medicaid |
$313.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.86
|
| Rate for Payer: Molina Healthcare Passport |
$313.59
|
| 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 |
$316.73
|
|
|
CYSTOSCOPY IMPLANT STENT(T
|
Facility
|
OP
|
$5,190.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761T2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.70 |
| Max. Negotiated Rate |
$4,982.40 |
| Rate for Payer: Aetna Commercial |
$3,996.30
|
| Rate for Payer: Anthem Medicaid |
$1,784.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cigna Commercial |
$4,307.70
|
| Rate for Payer: First Health Commercial |
$4,930.50
|
| Rate for Payer: Humana Commercial |
$4,411.50
|
| Rate for Payer: Humana KY Medicaid |
$1,784.84
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.90
|
| Rate for Payer: PHCS Commercial |
$4,982.40
|
| Rate for Payer: United Healthcare All Payer |
$4,567.20
|
|
|
CYSTOSCOPY IMPLANT STENT(T
|
Facility
|
IP
|
$5,190.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761T2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.70 |
| Max. Negotiated Rate |
$4,982.40 |
| Rate for Payer: Aetna Commercial |
$3,996.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.20
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cigna Commercial |
$4,307.70
|
| Rate for Payer: First Health Commercial |
$4,930.50
|
| Rate for Payer: Humana Commercial |
$4,411.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.90
|
| Rate for Payer: PHCS Commercial |
$4,982.40
|
| Rate for Payer: United Healthcare All Payer |
$4,567.20
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
IP
|
$5,991.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
76102082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.83 |
| Max. Negotiated Rate |
$5,751.36 |
| Rate for Payer: Aetna Commercial |
$4,613.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,672.98
|
| Rate for Payer: Cash Price |
$2,995.50
|
| Rate for Payer: Cigna Commercial |
$4,972.53
|
| Rate for Payer: First Health Commercial |
$5,691.45
|
| Rate for Payer: Humana Commercial |
$5,092.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,912.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,421.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,797.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,272.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,493.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,857.21
|
| Rate for Payer: PHCS Commercial |
$5,751.36
|
| Rate for Payer: United Healthcare All Payer |
$5,272.08
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
OP
|
$5,991.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
76102082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.83 |
| Max. Negotiated Rate |
$5,751.36 |
| Rate for Payer: Aetna Commercial |
$4,613.07
|
| Rate for Payer: Anthem Medicaid |
$2,060.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,672.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,995.50
|
| Rate for Payer: Cash Price |
$2,995.50
|
| Rate for Payer: Cigna Commercial |
$4,972.53
|
| Rate for Payer: First Health Commercial |
$5,691.45
|
| Rate for Payer: Humana Commercial |
$5,092.35
|
| Rate for Payer: Humana KY Medicaid |
$2,060.30
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,081.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,912.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,421.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,101.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,272.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,493.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,857.21
|
| Rate for Payer: PHCS Commercial |
$5,751.36
|
| Rate for Payer: United Healthcare All Payer |
$5,272.08
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Professional
|
Both
|
$5,991.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
76102082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$5,991.00 |
| Rate for Payer: Aetna Commercial |
$477.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$143.96
|
| Rate for Payer: Anthem Medicaid |
$101.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,991.00
|
| Rate for Payer: Cash Price |
$2,995.50
|
| Rate for Payer: Cash Price |
$2,995.50
|
| Rate for Payer: Cigna Commercial |
$424.41
|
| Rate for Payer: Healthspan PPO |
$494.57
|
| Rate for Payer: Humana Medicaid |
$101.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$393.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.53
|
| Rate for Payer: Molina Healthcare Passport |
$101.50
|
| Rate for Payer: Multiplan PHCS |
$3,594.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,193.70
|
| Rate for Payer: UHCCP Medicaid |
$151.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.52
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
761P2082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$477.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$143.96
|
| Rate for Payer: Anthem Medicaid |
$101.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$424.41
|
| Rate for Payer: Healthspan PPO |
$494.57
|
| Rate for Payer: Humana Medicaid |
$101.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$393.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.53
|
| Rate for Payer: Molina Healthcare Passport |
$101.50
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$151.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.52
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS(T
|
Facility
|
OP
|
$5,191.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
761T2082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.83 |
| Max. Negotiated Rate |
$4,983.36 |
| Rate for Payer: Aetna Commercial |
$3,997.07
|
| Rate for Payer: Anthem Medicaid |
$1,785.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,595.50
|
| Rate for Payer: Cash Price |
$2,595.50
|
| Rate for Payer: Cigna Commercial |
$4,308.53
|
| Rate for Payer: First Health Commercial |
$4,931.45
|
| Rate for Payer: Humana Commercial |
$4,412.35
|
| Rate for Payer: Humana KY Medicaid |
$1,785.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.21
|
| Rate for Payer: PHCS Commercial |
$4,983.36
|
| Rate for Payer: United Healthcare All Payer |
$4,568.08
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS(T
|
Facility
|
IP
|
$5,191.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
761T2082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.83 |
| Max. Negotiated Rate |
$4,983.36 |
| Rate for Payer: Aetna Commercial |
$3,997.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.98
|
| Rate for Payer: Cash Price |
$2,595.50
|
| Rate for Payer: Cigna Commercial |
$4,308.53
|
| Rate for Payer: First Health Commercial |
$4,931.45
|
| Rate for Payer: Humana Commercial |
$4,412.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.21
|
| Rate for Payer: PHCS Commercial |
$4,983.36
|
| Rate for Payer: United Healthcare All Payer |
$4,568.08
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
76102092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.65 |
| Max. Negotiated Rate |
$5,764.80 |
| Rate for Payer: Aetna Commercial |
$4,623.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,683.90
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$4,984.15
|
| Rate for Payer: First Health Commercial |
$5,704.75
|
| Rate for Payer: Humana Commercial |
$5,104.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,924.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,431.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,284.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,861.55
|
| Rate for Payer: PHCS Commercial |
$5,764.80
|
| Rate for Payer: United Healthcare All Payer |
$5,284.40
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Professional
|
Both
|
$6,005.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
76102092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$6,005.00 |
| Rate for Payer: Aetna Commercial |
$414.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.58
|
| Rate for Payer: Anthem Medicaid |
$237.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,005.00
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$368.75
|
| Rate for Payer: Healthspan PPO |
$701.32
|
| Rate for Payer: Humana Medicaid |
$237.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.67
|
| Rate for Payer: Molina Healthcare Passport |
$237.91
|
| Rate for Payer: Multiplan PHCS |
$3,603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,203.50
|
| Rate for Payer: UHCCP Medicaid |
$130.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.29
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
76102092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.65 |
| Max. Negotiated Rate |
$5,764.80 |
| Rate for Payer: Aetna Commercial |
$4,623.85
|
| Rate for Payer: Anthem Medicaid |
$2,065.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,683.90
|
| 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 |
$3,002.50
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$4,984.15
|
| Rate for Payer: First Health Commercial |
$5,704.75
|
| Rate for Payer: Humana Commercial |
$5,104.25
|
| Rate for Payer: Humana KY Medicaid |
$2,065.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,086.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,924.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,431.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,106.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,284.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,861.55
|
| Rate for Payer: PHCS Commercial |
$5,764.80
|
| Rate for Payer: United Healthcare All Payer |
$5,284.40
|
|
|
CYSTOSCOPY & REVISE URETHRA(P
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
761P2092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$701.32 |
| Rate for Payer: Aetna Commercial |
$414.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.58
|
| Rate for Payer: Anthem Medicaid |
$237.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$455.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$368.75
|
| Rate for Payer: Healthspan PPO |
$701.32
|
| Rate for Payer: Humana Medicaid |
$237.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.67
|
| Rate for Payer: Molina Healthcare Passport |
$237.91
|
| Rate for Payer: Multiplan PHCS |
$273.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$318.50
|
| Rate for Payer: UHCCP Medicaid |
$130.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.29
|
|
|
CYSTOSCOPY & REVISE URETHRA(T
|
Facility
|
IP
|
$5,550.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
761T2092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.50 |
| Max. Negotiated Rate |
$5,328.00 |
| Rate for Payer: Aetna Commercial |
$4,273.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,329.00
|
| Rate for Payer: Cash Price |
$2,775.00
|
| Rate for Payer: Cigna Commercial |
$4,606.50
|
| Rate for Payer: First Health Commercial |
$5,272.50
|
| Rate for Payer: Humana Commercial |
$4,717.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,551.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,884.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,720.50
|
| Rate for Payer: PHCS Commercial |
$5,328.00
|
| Rate for Payer: United Healthcare All Payer |
$4,884.00
|
|
|
CYSTOSCOPY & REVISE URETHRA(T
|
Facility
|
OP
|
$5,550.00
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
761T2092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.50 |
| Max. Negotiated Rate |
$5,328.00 |
| Rate for Payer: Aetna Commercial |
$4,273.50
|
| Rate for Payer: Anthem Medicaid |
$1,908.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,329.00
|
| 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 |
$2,775.00
|
| Rate for Payer: Cash Price |
$2,775.00
|
| Rate for Payer: Cigna Commercial |
$4,606.50
|
| Rate for Payer: First Health Commercial |
$5,272.50
|
| Rate for Payer: Humana Commercial |
$4,717.50
|
| Rate for Payer: Humana KY Medicaid |
$1,908.64
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,928.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,551.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,946.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,884.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,720.50
|
| Rate for Payer: PHCS Commercial |
$5,328.00
|
| Rate for Payer: United Healthcare All Payer |
$4,884.00
|
|
|
CYSTOSCOPY & URETER CATHETE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
761P2083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$219.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.62
|
| Rate for Payer: Anthem Medicaid |
$133.90
|
| 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 |
$191.64
|
| Rate for Payer: Healthspan PPO |
$362.16
|
| Rate for Payer: Humana Medicaid |
$133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.58
|
| Rate for Payer: Molina Healthcare Passport |
$133.90
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.24
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
IP
|
$6,212.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
76102083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$807.56 |
| Max. Negotiated Rate |
$5,963.52 |
| Rate for Payer: Aetna Commercial |
$4,783.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,845.36
|
| Rate for Payer: Cash Price |
$3,106.00
|
| Rate for Payer: Cigna Commercial |
$5,155.96
|
| Rate for Payer: First Health Commercial |
$5,901.40
|
| Rate for Payer: Humana Commercial |
$5,280.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,093.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,584.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,863.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,466.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$807.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,925.72
|
| Rate for Payer: PHCS Commercial |
$5,963.52
|
| Rate for Payer: United Healthcare All Payer |
$5,466.56
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$6,212.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
76102083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$807.56 |
| Max. Negotiated Rate |
$5,963.52 |
| Rate for Payer: Cash Price |
$3,106.00
|
| Rate for Payer: Aetna Commercial |
$4,783.24
|
| Rate for Payer: Anthem Medicaid |
$2,136.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,845.36
|
| 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 |
$3,106.00
|
| Rate for Payer: Cigna Commercial |
$5,155.96
|
| Rate for Payer: First Health Commercial |
$5,901.40
|
| Rate for Payer: Humana Commercial |
$5,280.20
|
| Rate for Payer: Humana KY Medicaid |
$2,136.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,158.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,093.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,584.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,179.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,466.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$807.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,925.72
|
| Rate for Payer: PHCS Commercial |
$5,963.52
|
| Rate for Payer: United Healthcare All Payer |
$5,466.56
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Professional
|
Both
|
$6,212.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
76102083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$6,212.00 |
| Rate for Payer: Aetna Commercial |
$219.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.62
|
| Rate for Payer: Anthem Medicaid |
$133.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,212.00
|
| Rate for Payer: Cash Price |
$3,106.00
|
| Rate for Payer: Cash Price |
$3,106.00
|
| Rate for Payer: Cigna Commercial |
$191.64
|
| Rate for Payer: Healthspan PPO |
$362.16
|
| Rate for Payer: Humana Medicaid |
$133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.58
|
| Rate for Payer: Molina Healthcare Passport |
$133.90
|
| Rate for Payer: Multiplan PHCS |
$3,727.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,348.40
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.24
|
|
|
CYSTOSCOPY & URETER CATHETE(T
|
Facility
|
OP
|
$5,212.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
761T2083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.56 |
| Max. Negotiated Rate |
$5,003.52 |
| Rate for Payer: Aetna Commercial |
$4,013.24
|
| Rate for Payer: Anthem Medicaid |
$1,792.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,065.36
|
| 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 |
$2,606.00
|
| Rate for Payer: Cash Price |
$2,606.00
|
| Rate for Payer: Cigna Commercial |
$4,325.96
|
| Rate for Payer: First Health Commercial |
$4,951.40
|
| Rate for Payer: Humana Commercial |
$4,430.20
|
| Rate for Payer: Humana KY Medicaid |
$1,792.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,810.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,273.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,846.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,828.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,586.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,909.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.72
|
| Rate for Payer: PHCS Commercial |
$5,003.52
|
| Rate for Payer: United Healthcare All Payer |
$4,586.56
|
|
