|
CYSTOSCOPY & URETER CATHETE(T
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$4,065.36
|
| 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: 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 |
$1,563.60
|
| 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
|
|
|
CYSTOSTO CYSTO W DRAINAGE
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
45000277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
CYSTOSTO CYSTO W DRAINAGE
|
Facility
|
OP
|
$7,526.93
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
76102059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.50 |
| Max. Negotiated Rate |
$7,225.85 |
| Rate for Payer: Aetna Commercial |
$5,795.74
|
| Rate for Payer: Anthem Medicaid |
$2,588.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,871.01
|
| 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 |
$3,763.47
|
| Rate for Payer: Cash Price |
$3,763.47
|
| Rate for Payer: Cigna Commercial |
$6,247.35
|
| Rate for Payer: First Health Commercial |
$7,150.58
|
| Rate for Payer: Humana Commercial |
$6,397.89
|
| Rate for Payer: Humana KY Medicaid |
$2,588.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,172.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.35
|
| Rate for Payer: PHCS Commercial |
$7,225.85
|
| Rate for Payer: United Healthcare All Payer |
$6,623.70
|
|
|
CYSTOSTO CYSTO W DRAINAGE
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
45000277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem Medicaid |
$909.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| 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 |
$1,322.50
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Humana KY Medicaid |
$909.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$918.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$927.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
CYSTOSTO CYSTO W DRAINAGE
|
Professional
|
Both
|
$7,526.93
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
76102059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.22 |
| Max. Negotiated Rate |
$7,526.93 |
| Rate for Payer: Aetna Commercial |
$467.82
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,526.93
|
| Rate for Payer: Cash Price |
$3,763.47
|
| Rate for Payer: Cash Price |
$3,763.47
|
| Rate for Payer: Cigna Commercial |
$418.53
|
| Rate for Payer: Healthspan PPO |
$374.07
|
| Rate for Payer: Humana Medicaid |
$278.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$393.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$283.78
|
| Rate for Payer: Molina Healthcare Passport |
$278.22
|
| Rate for Payer: Multiplan PHCS |
$4,516.16
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,268.85
|
| Rate for Payer: UHCCP Medicaid |
$2,634.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.00
|
|
|
CYSTOSTO CYSTO W DRAINAGE
|
Facility
|
IP
|
$7,526.93
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
76102059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.50 |
| Max. Negotiated Rate |
$7,225.85 |
| Rate for Payer: Aetna Commercial |
$5,795.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,871.01
|
| Rate for Payer: Cash Price |
$3,763.47
|
| Rate for Payer: Cigna Commercial |
$6,247.35
|
| Rate for Payer: First Health Commercial |
$7,150.58
|
| Rate for Payer: Humana Commercial |
$6,397.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,172.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.35
|
| Rate for Payer: PHCS Commercial |
$7,225.85
|
| Rate for Payer: United Healthcare All Payer |
$6,623.70
|
|
|
CYSTOSTO CYSTO W DRAINAGE(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
761P2059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.22 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$467.82
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$418.53
|
| Rate for Payer: Healthspan PPO |
$374.07
|
| Rate for Payer: Humana Medicaid |
$278.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$393.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$283.78
|
| Rate for Payer: Molina Healthcare Passport |
$278.22
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.00
|
|
|
CYSTOSTO CYSTO W DRAINAGE(T
|
Facility
|
IP
|
$5,826.93
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
761T2059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.50 |
| Max. Negotiated Rate |
$5,593.85 |
| Rate for Payer: Aetna Commercial |
$4,486.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,545.01
|
| Rate for Payer: Cash Price |
$2,913.47
|
| Rate for Payer: Cigna Commercial |
$4,836.35
|
| Rate for Payer: First Health Commercial |
$5,535.58
|
| Rate for Payer: Humana Commercial |
$4,952.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,778.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,300.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,748.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,370.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.35
|
| Rate for Payer: PHCS Commercial |
$5,593.85
|
| Rate for Payer: United Healthcare All Payer |
$5,127.70
|
|
|
CYSTOSTO CYSTO W DRAINAGE(T
|
Facility
|
OP
|
$5,826.93
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
761T2059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.50 |
| Max. Negotiated Rate |
$5,593.85 |
| Rate for Payer: Aetna Commercial |
$4,486.74
|
| Rate for Payer: Anthem Medicaid |
$2,003.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,545.01
|
| 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 |
$2,913.47
|
| Rate for Payer: Cash Price |
$2,913.47
|
| Rate for Payer: Cigna Commercial |
$4,836.35
|
| Rate for Payer: First Health Commercial |
$5,535.58
|
| Rate for Payer: Humana Commercial |
$4,952.89
|
| Rate for Payer: Humana KY Medicaid |
$2,003.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,024.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,778.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,300.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,044.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,370.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.35
|
| Rate for Payer: PHCS Commercial |
$5,593.85
|
| Rate for Payer: United Healthcare All Payer |
$5,127.70
|
|
|
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 51040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.34 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
|
|
CYSTOTOMY,W/EVAC BLOOD CLOTS
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
76102795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CYSTOTOMY,W/EVAC BLOOD CLOTS
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
76102795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CYSTOTOMY,W/EVAC BLOOD CLOTS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 53899
|
| Hospital Charge Code |
76102795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Anthem Medicaid |
$50.00
|
| 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: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$50.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.00
|
| Rate for Payer: Molina Healthcare Passport |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.50
|
|
|
CYSTO/URETERO STRICTURE TX
|
Professional
|
Both
|
$5,314.46
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
76102105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.60 |
| Max. Negotiated Rate |
$5,314.46 |
| Rate for Payer: Aetna Commercial |
$637.77
|
| Rate for Payer: Anthem Medicaid |
$311.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,314.46
|
| Rate for Payer: Cash Price |
$2,657.23
|
| Rate for Payer: Cash Price |
$2,657.23
|
| Rate for Payer: Cigna Commercial |
$616.01
|
| Rate for Payer: Healthspan PPO |
$509.95
|
| Rate for Payer: Humana Medicaid |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$521.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.83
|
| Rate for Payer: Molina Healthcare Passport |
$311.60
|
| Rate for Payer: Multiplan PHCS |
$3,188.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,720.12
|
| Rate for Payer: UHCCP Medicaid |
$1,860.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.72
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
OP
|
$5,314.46
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
76102105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.88 |
| Max. Negotiated Rate |
$5,101.88 |
| Rate for Payer: Aetna Commercial |
$4,092.13
|
| Rate for Payer: Anthem Medicaid |
$1,827.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.28
|
| 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 |
$2,657.23
|
| Rate for Payer: Cash Price |
$2,657.23
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$5,048.74
|
| Rate for Payer: Humana Commercial |
$4,517.29
|
| Rate for Payer: Humana KY Medicaid |
$1,827.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,357.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,864.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,676.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,985.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,062.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.48
|
| Rate for Payer: PHCS Commercial |
$5,101.88
|
| Rate for Payer: United Healthcare All Payer |
$4,676.72
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
IP
|
$5,314.46
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
76102105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.88 |
| Max. Negotiated Rate |
$5,101.88 |
| Rate for Payer: Aetna Commercial |
$4,092.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.28
|
| Rate for Payer: Cash Price |
$2,657.23
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$5,048.74
|
| Rate for Payer: Humana Commercial |
$4,517.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,357.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,676.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,985.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,062.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.48
|
| Rate for Payer: PHCS Commercial |
$5,101.88
|
| Rate for Payer: United Healthcare All Payer |
$4,676.72
|
|
|
CYSTO/URETERO STRICTURE TX(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
761P2105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$637.77
|
| Rate for Payer: Anthem Medicaid |
$311.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$616.01
|
| Rate for Payer: Healthspan PPO |
$509.95
|
| Rate for Payer: Humana Medicaid |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$521.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.83
|
| Rate for Payer: Molina Healthcare Passport |
$311.60
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.72
|
|
|
CYSTO/URETERO STRICTURE TX(T
|
Facility
|
OP
|
$4,614.46
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
761T2105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.88 |
| Max. Negotiated Rate |
$4,429.88 |
| Rate for Payer: Aetna Commercial |
$3,553.13
|
| Rate for Payer: Anthem Medicaid |
$1,586.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.28
|
| 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 |
$2,307.23
|
| Rate for Payer: Cash Price |
$2,307.23
|
| Rate for Payer: Cigna Commercial |
$3,830.00
|
| Rate for Payer: First Health Commercial |
$4,383.74
|
| Rate for Payer: Humana Commercial |
$3,922.29
|
| Rate for Payer: Humana KY Medicaid |
$1,586.91
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,405.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,618.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.48
|
| Rate for Payer: PHCS Commercial |
$4,429.88
|
| Rate for Payer: United Healthcare All Payer |
$4,060.72
|
|
|
CYSTO/URETERO STRICTURE TX(T
|
Facility
|
IP
|
$4,614.46
|
|
|
Service Code
|
HCPCS 52344
|
| Hospital Charge Code |
761T2105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.88 |
| Max. Negotiated Rate |
$4,429.88 |
| Rate for Payer: Aetna Commercial |
$3,553.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.28
|
| Rate for Payer: Cash Price |
$2,307.23
|
| Rate for Payer: Cigna Commercial |
$3,830.00
|
| Rate for Payer: First Health Commercial |
$4,383.74
|
| Rate for Payer: Humana Commercial |
$3,922.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,405.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.48
|
| Rate for Payer: PHCS Commercial |
$4,429.88
|
| Rate for Payer: United Healthcare All Payer |
$4,060.72
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Professional
|
Both
|
$10,591.40
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
76102111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$10,591.40 |
| Rate for Payer: Anthem Medicaid |
$334.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$10,591.40
|
| Rate for Payer: Cash Price |
$5,295.70
|
| Rate for Payer: Cash Price |
$5,295.70
|
| Rate for Payer: Cigna Commercial |
$682.79
|
| Rate for Payer: Healthspan PPO |
$535.50
|
| Rate for Payer: Humana Medicaid |
$334.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.99
|
| Rate for Payer: Molina Healthcare Passport |
$334.30
|
| Rate for Payer: Multiplan PHCS |
$6,354.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,413.98
|
| Rate for Payer: UHCCP Medicaid |
$3,706.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.64
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
IP
|
$10,591.40
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
76102111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.88 |
| Max. Negotiated Rate |
$10,167.74 |
| Rate for Payer: Aetna Commercial |
$8,155.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,261.29
|
| Rate for Payer: Cash Price |
$5,295.70
|
| Rate for Payer: Cigna Commercial |
$8,790.86
|
| Rate for Payer: First Health Commercial |
$10,061.83
|
| Rate for Payer: Humana Commercial |
$9,002.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,684.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,816.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,177.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,320.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,943.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,118.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,376.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,283.33
|
| Rate for Payer: PHCS Commercial |
$10,167.74
|
| Rate for Payer: United Healthcare All Payer |
$9,320.43
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
OP
|
$10,591.40
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
76102111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.88 |
| Max. Negotiated Rate |
$10,167.74 |
| Rate for Payer: Aetna Commercial |
$8,155.38
|
| Rate for Payer: Anthem Medicaid |
$3,642.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,261.29
|
| 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 |
$5,295.70
|
| Rate for Payer: Cash Price |
$5,295.70
|
| Rate for Payer: Cigna Commercial |
$8,790.86
|
| Rate for Payer: First Health Commercial |
$10,061.83
|
| Rate for Payer: Humana Commercial |
$9,002.69
|
| Rate for Payer: Humana KY Medicaid |
$3,642.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,679.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,684.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,816.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,715.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,320.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,943.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,118.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,376.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,283.33
|
| Rate for Payer: PHCS Commercial |
$10,167.74
|
| Rate for Payer: United Healthcare All Payer |
$9,320.43
|
|
|
CYSTO/URETERO W/LITHOTRIPSY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
761P2111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Anthem Medicaid |
$334.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$682.79
|
| Rate for Payer: Healthspan PPO |
$535.50
|
| Rate for Payer: Humana Medicaid |
$334.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.99
|
| Rate for Payer: Molina Healthcare Passport |
$334.30
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.64
|
|
|
CYSTO/URETERO W/LITHOTRIPSY(T
|
Facility
|
IP
|
$9,741.40
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
761T2111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,266.38 |
| Max. Negotiated Rate |
$9,351.74 |
| Rate for Payer: Aetna Commercial |
$7,500.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,598.29
|
| Rate for Payer: Cash Price |
$4,870.70
|
| Rate for Payer: Cigna Commercial |
$8,085.36
|
| Rate for Payer: First Health Commercial |
$9,254.33
|
| Rate for Payer: Humana Commercial |
$8,280.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,987.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,189.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,922.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,572.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,306.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,948.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.83
|
| Rate for Payer: PHCS Commercial |
$9,351.74
|
| Rate for Payer: United Healthcare All Payer |
$8,572.43
|
|
|
CYSTO/URETERO W/LITHOTRIPSY(T
|
Facility
|
OP
|
$9,741.40
|
|
|
Service Code
|
HCPCS 52356
|
| Hospital Charge Code |
761T2111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,266.38 |
| Max. Negotiated Rate |
$9,351.74 |
| Rate for Payer: Aetna Commercial |
$7,500.88
|
| Rate for Payer: Anthem Medicaid |
$3,350.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,598.29
|
| 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 |
$4,870.70
|
| Rate for Payer: Cash Price |
$4,870.70
|
| Rate for Payer: Cigna Commercial |
$8,085.36
|
| Rate for Payer: First Health Commercial |
$9,254.33
|
| Rate for Payer: Humana Commercial |
$8,280.19
|
| Rate for Payer: Humana KY Medicaid |
$3,350.07
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,384.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,987.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,189.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,417.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,572.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,306.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,948.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.83
|
| Rate for Payer: PHCS Commercial |
$9,351.74
|
| Rate for Payer: United Healthcare All Payer |
$8,572.43
|
|
