|
CYSTOURETERO W/RENAL STRICT
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
HCPCS 52346
|
| Hospital Charge Code |
76102877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$1,044.48 |
| Rate for Payer: Aetna Commercial |
$837.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$848.64
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$903.04
|
| Rate for Payer: First Health Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial |
$924.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$957.44
|
| Rate for Payer: Ohio Health Group HMO |
$816.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.28
|
| Rate for Payer: PHCS Commercial |
$1,044.48
|
| Rate for Payer: United Healthcare All Payer |
$957.44
|
|
|
CYSTOURETERO W/RENAL STRICT
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 52346
|
| Hospital Charge Code |
76102877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.63 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna Commercial |
$767.46
|
| Rate for Payer: Anthem Medicaid |
$373.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,088.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$732.39
|
| Rate for Payer: Healthspan PPO |
$613.66
|
| Rate for Payer: Humana Medicaid |
$373.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.10
|
| Rate for Payer: Molina Healthcare Passport |
$373.63
|
| Rate for Payer: Multiplan PHCS |
$652.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$761.60
|
| Rate for Payer: UHCCP Medicaid |
$380.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.37
|
|
|
CYSTOURETERO W/RENAL STRICT
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
HCPCS 52346
|
| Hospital Charge Code |
76102877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$837.76
|
| Rate for Payer: Anthem Medicaid |
$374.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$848.64
|
| 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 |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$903.04
|
| Rate for Payer: First Health Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial |
$924.80
|
| Rate for Payer: Humana KY Medicaid |
$374.16
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$377.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$957.44
|
| Rate for Payer: Ohio Health Group HMO |
$816.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.28
|
| Rate for Payer: PHCS Commercial |
$1,044.48
|
| Rate for Payer: United Healthcare All Payer |
$957.44
|
|
|
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$827.01
|
|
|
Service Code
|
CPT 52000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$590.72 |
| Max. Negotiated Rate |
$827.01 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
|
|
CYSTOURETHROSCOPY SEP PX
|
Professional
|
Both
|
$4,219.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
76102081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$4,219.00 |
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.84
|
| Rate for Payer: Anthem Medicaid |
$83.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,219.00
|
| Rate for Payer: Cash Price |
$2,109.50
|
| Rate for Payer: Cash Price |
$2,109.50
|
| Rate for Payer: Cigna Commercial |
$314.10
|
| Rate for Payer: Healthspan PPO |
$264.55
|
| Rate for Payer: Humana Medicaid |
$83.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.94
|
| Rate for Payer: Molina Healthcare Passport |
$83.27
|
| Rate for Payer: Multiplan PHCS |
$2,531.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,953.30
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.10
|
|
|
CYSTOURETHROSCOPY SEP PX
|
Facility
|
IP
|
$4,219.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
76102081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$548.47 |
| Max. Negotiated Rate |
$4,050.24 |
| Rate for Payer: Aetna Commercial |
$3,248.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.82
|
| Rate for Payer: Cash Price |
$2,109.50
|
| Rate for Payer: Cigna Commercial |
$3,501.77
|
| Rate for Payer: First Health Commercial |
$4,008.05
|
| Rate for Payer: Humana Commercial |
$3,586.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.89
|
| Rate for Payer: PHCS Commercial |
$4,050.24
|
| Rate for Payer: United Healthcare All Payer |
$3,712.72
|
|
|
CYSTOURETHROSCOPY SEP PX
|
Facility
|
OP
|
$4,219.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
76102081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$548.47 |
| Max. Negotiated Rate |
$4,050.24 |
| Rate for Payer: Aetna Commercial |
$3,248.63
|
| Rate for Payer: Anthem Medicaid |
$1,450.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$2,109.50
|
| Rate for Payer: Cash Price |
$2,109.50
|
| Rate for Payer: Cigna Commercial |
$3,501.77
|
| Rate for Payer: First Health Commercial |
$4,008.05
|
| Rate for Payer: Humana Commercial |
$3,586.15
|
| Rate for Payer: Humana KY Medicaid |
$1,450.91
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,480.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,164.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.89
|
| Rate for Payer: PHCS Commercial |
$4,050.24
|
| Rate for Payer: United Healthcare All Payer |
$3,712.72
|
|
|
CYSTOURETHROSCOPY SEP PX(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
761P2081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$204.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.84
|
| Rate for Payer: Anthem Medicaid |
$83.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$314.10
|
| Rate for Payer: Healthspan PPO |
$264.55
|
| Rate for Payer: Humana Medicaid |
$83.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.94
|
| Rate for Payer: Molina Healthcare Passport |
$83.27
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.10
|
|
|
CYSTOURETHROSCOPY SEP PX(T
|
Facility
|
OP
|
$3,619.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
761T2081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.47 |
| Max. Negotiated Rate |
$3,474.24 |
| Rate for Payer: Aetna Commercial |
$2,786.63
|
| Rate for Payer: Anthem Medicaid |
$1,244.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,822.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cigna Commercial |
$3,003.77
|
| Rate for Payer: First Health Commercial |
$3,438.05
|
| Rate for Payer: Humana Commercial |
$3,076.15
|
| Rate for Payer: Humana KY Medicaid |
$1,244.57
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,257.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,967.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,670.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,184.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,714.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.89
|
| Rate for Payer: PHCS Commercial |
$3,474.24
|
| Rate for Payer: United Healthcare All Payer |
$3,184.72
|
|
|
CYSTOURETHROSCOPY SEP PX(T
|
Facility
|
IP
|
$3,619.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
761T2081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.47 |
| Max. Negotiated Rate |
$3,474.24 |
| Rate for Payer: Aetna Commercial |
$2,786.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,822.82
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cigna Commercial |
$3,003.77
|
| Rate for Payer: First Health Commercial |
$3,438.05
|
| Rate for Payer: Humana Commercial |
$3,076.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,967.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,670.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,184.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,714.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.89
|
| Rate for Payer: PHCS Commercial |
$3,474.24
|
| Rate for Payer: United Healthcare All Payer |
$3,184.72
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Facility
|
OP
|
$5,329.64
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
761T2084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.85 |
| Max. Negotiated Rate |
$5,116.45 |
| Rate for Payer: Aetna Commercial |
$4,103.82
|
| Rate for Payer: Anthem Medicaid |
$1,832.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,157.12
|
| 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 |
$2,664.82
|
| Rate for Payer: Cash Price |
$2,664.82
|
| Rate for Payer: Cigna Commercial |
$4,423.60
|
| Rate for Payer: First Health Commercial |
$5,063.16
|
| Rate for Payer: Humana Commercial |
$4,530.19
|
| Rate for Payer: Humana KY Medicaid |
$1,832.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,851.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,933.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,869.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,690.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,997.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.19
|
| Rate for Payer: PHCS Commercial |
$5,116.45
|
| Rate for Payer: United Healthcare All Payer |
$4,690.08
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Facility
|
IP
|
$6,129.64
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
76102084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$796.85 |
| Max. Negotiated Rate |
$5,884.45 |
| Rate for Payer: Aetna Commercial |
$4,719.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,781.12
|
| Rate for Payer: Cash Price |
$3,064.82
|
| Rate for Payer: Cigna Commercial |
$5,087.60
|
| Rate for Payer: First Health Commercial |
$5,823.16
|
| Rate for Payer: Humana Commercial |
$5,210.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,026.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,523.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,838.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,394.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,597.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,900.19
|
| Rate for Payer: PHCS Commercial |
$5,884.45
|
| Rate for Payer: United Healthcare All Payer |
$5,394.08
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Professional
|
Both
|
$6,129.64
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
76102084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.63 |
| Max. Negotiated Rate |
$6,129.64 |
| Rate for Payer: Aetna Commercial |
$232.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.63
|
| Rate for Payer: Anthem Medicaid |
$139.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,129.64
|
| Rate for Payer: Cash Price |
$3,064.82
|
| Rate for Payer: Cash Price |
$3,064.82
|
| Rate for Payer: Cigna Commercial |
$204.01
|
| Rate for Payer: Healthspan PPO |
$549.49
|
| Rate for Payer: Humana Medicaid |
$139.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.99
|
| Rate for Payer: Molina Healthcare Passport |
$139.21
|
| Rate for Payer: Multiplan PHCS |
$3,677.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,290.75
|
| Rate for Payer: UHCCP Medicaid |
$113.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.60
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Facility
|
OP
|
$6,129.64
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
76102084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$796.85 |
| Max. Negotiated Rate |
$5,884.45 |
| Rate for Payer: Aetna Commercial |
$4,719.82
|
| Rate for Payer: Anthem Medicaid |
$2,107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,781.12
|
| 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 |
$3,064.82
|
| Rate for Payer: Cash Price |
$3,064.82
|
| Rate for Payer: Cigna Commercial |
$5,087.60
|
| Rate for Payer: First Health Commercial |
$5,823.16
|
| Rate for Payer: Humana Commercial |
$5,210.19
|
| Rate for Payer: Humana KY Medicaid |
$2,107.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,129.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,026.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,523.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,150.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,394.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,597.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,900.19
|
| Rate for Payer: PHCS Commercial |
$5,884.45
|
| Rate for Payer: United Healthcare All Payer |
$5,394.08
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
761P2084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.63 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$232.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.63
|
| Rate for Payer: Anthem Medicaid |
$139.21
|
| 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 |
$204.01
|
| Rate for Payer: Healthspan PPO |
$549.49
|
| Rate for Payer: Humana Medicaid |
$139.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.99
|
| Rate for Payer: Molina Healthcare Passport |
$139.21
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$113.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.60
|
|
|
CYSTOURETHROSCOPY, W/BIOPSY(S)
|
Facility
|
IP
|
$5,329.64
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
761T2084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.85 |
| Max. Negotiated Rate |
$5,116.45 |
| Rate for Payer: Aetna Commercial |
$4,103.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,157.12
|
| Rate for Payer: Cash Price |
$2,664.82
|
| Rate for Payer: Cigna Commercial |
$4,423.60
|
| Rate for Payer: First Health Commercial |
$5,063.16
|
| Rate for Payer: Humana Commercial |
$4,530.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,933.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,690.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,997.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.19
|
| Rate for Payer: PHCS Commercial |
$5,116.45
|
| Rate for Payer: United Healthcare All Payer |
$4,690.08
|
|
|
CYSTOURETHROSCOPY, WITH BIOPSY(S)
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 52204
|
|
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
|
|
|
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 52281
|
|
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
|
|
|
CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 52276
|
|
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
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S)
|
Facility
|
OP
|
$6,264.36
|
|
|
Service Code
|
CPT 52240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,474.54 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 UP TO 2.0 CM)
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE, BLADDER NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52214
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT OF MINOR (LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
