|
CYSTO W/COMP RMV STONE/STENT
|
Professional
|
Both
|
$7,113.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
76102097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$7,113.00 |
| Rate for Payer: Aetna Commercial |
$457.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.42
|
| Rate for Payer: Anthem Medicaid |
$271.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,113.00
|
| Rate for Payer: Cash Price |
$3,556.50
|
| Rate for Payer: Cash Price |
$3,556.50
|
| Rate for Payer: Cigna Commercial |
$408.11
|
| Rate for Payer: Healthspan PPO |
$569.65
|
| Rate for Payer: Humana Medicaid |
$271.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$375.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.20
|
| Rate for Payer: Molina Healthcare Passport |
$271.76
|
| Rate for Payer: Multiplan PHCS |
$4,267.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,979.10
|
| Rate for Payer: UHCCP Medicaid |
$165.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.48
|
|
|
CYSTO W/COMP RMV STONE/STENT
|
Facility
|
IP
|
$7,113.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
76102097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.69 |
| Max. Negotiated Rate |
$6,828.48 |
| Rate for Payer: Aetna Commercial |
$5,477.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,548.14
|
| Rate for Payer: Cash Price |
$3,556.50
|
| Rate for Payer: Cigna Commercial |
$5,903.79
|
| Rate for Payer: First Health Commercial |
$6,757.35
|
| Rate for Payer: Humana Commercial |
$6,046.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,832.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,249.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,259.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.03
|
| Rate for Payer: PHCS Commercial |
$6,828.48
|
| Rate for Payer: United Healthcare All Payer |
$6,259.44
|
|
|
CYSTO W/COMP RMV STONE/STENT
|
Facility
|
OP
|
$7,113.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
76102097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.69 |
| Max. Negotiated Rate |
$6,828.48 |
| Rate for Payer: Aetna Commercial |
$5,477.01
|
| Rate for Payer: Anthem Medicaid |
$2,446.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,548.14
|
| 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 |
$3,556.50
|
| Rate for Payer: Cash Price |
$3,556.50
|
| Rate for Payer: Cigna Commercial |
$5,903.79
|
| Rate for Payer: First Health Commercial |
$6,757.35
|
| Rate for Payer: Humana Commercial |
$6,046.05
|
| Rate for Payer: Humana KY Medicaid |
$2,446.16
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,471.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,832.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,249.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,495.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,259.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.03
|
| Rate for Payer: PHCS Commercial |
$6,828.48
|
| Rate for Payer: United Healthcare All Payer |
$6,259.44
|
|
|
CYSTO W/COMP RMV STONE/STENT(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
761P2097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$457.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.42
|
| Rate for Payer: Anthem Medicaid |
$271.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$408.11
|
| Rate for Payer: Healthspan PPO |
$569.65
|
| Rate for Payer: Humana Medicaid |
$271.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$375.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.20
|
| Rate for Payer: Molina Healthcare Passport |
$271.76
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$165.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.48
|
|
|
CYSTO W/COMP RMV STONE/STENT(T
|
Facility
|
IP
|
$5,913.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
761T2097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.69 |
| Max. Negotiated Rate |
$5,676.48 |
| Rate for Payer: Aetna Commercial |
$4,553.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,612.14
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cigna Commercial |
$4,907.79
|
| Rate for Payer: First Health Commercial |
$5,617.35
|
| Rate for Payer: Humana Commercial |
$5,026.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,848.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,363.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,773.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,203.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,434.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,182.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,833.03
|
| Rate for Payer: PHCS Commercial |
$5,676.48
|
| Rate for Payer: United Healthcare All Payer |
$5,203.44
|
|
|
CYSTO W/COMP RMV STONE/STENT(T
|
Facility
|
OP
|
$5,913.00
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
761T2097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.69 |
| Max. Negotiated Rate |
$5,676.48 |
| Rate for Payer: Aetna Commercial |
$4,553.01
|
| Rate for Payer: Anthem Medicaid |
$2,033.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,612.14
|
| 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 |
$2,956.50
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cigna Commercial |
$4,907.79
|
| Rate for Payer: First Health Commercial |
$5,617.35
|
| Rate for Payer: Humana Commercial |
$5,026.05
|
| Rate for Payer: Humana KY Medicaid |
$2,033.48
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,054.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,848.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,363.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,074.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,203.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,434.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,182.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,833.03
|
| Rate for Payer: PHCS Commercial |
$5,676.48
|
| Rate for Payer: United Healthcare All Payer |
$5,203.44
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
761P2085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$358.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.44
|
| Rate for Payer: Anthem Medicaid |
$190.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,975.00
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$292.39
|
| Rate for Payer: Healthspan PPO |
$723.97
|
| Rate for Payer: Humana Medicaid |
$190.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$284.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.59
|
| Rate for Payer: Molina Healthcare Passport |
$190.77
|
| Rate for Payer: Multiplan PHCS |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,382.50
|
| Rate for Payer: UHCCP Medicaid |
$144.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.68
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$7,113.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
76102085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$7,113.17 |
| Rate for Payer: Aetna Commercial |
$358.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.44
|
| Rate for Payer: Anthem Medicaid |
$190.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,113.17
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cigna Commercial |
$292.39
|
| Rate for Payer: Healthspan PPO |
$723.97
|
| Rate for Payer: Humana Medicaid |
$190.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$284.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.59
|
| Rate for Payer: Molina Healthcare Passport |
$190.77
|
| Rate for Payer: Multiplan PHCS |
$4,267.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,979.22
|
| Rate for Payer: UHCCP Medicaid |
$144.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.68
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Facility
|
IP
|
$7,113.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
76102085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.71 |
| Max. Negotiated Rate |
$6,828.64 |
| Rate for Payer: Aetna Commercial |
$5,477.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,548.27
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cigna Commercial |
$5,903.93
|
| Rate for Payer: First Health Commercial |
$6,757.51
|
| Rate for Payer: Humana Commercial |
$6,046.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,832.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,249.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,259.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.08
|
| Rate for Payer: PHCS Commercial |
$6,828.64
|
| Rate for Payer: United Healthcare All Payer |
$6,259.59
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Facility
|
OP
|
$7,113.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
76102085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.71 |
| Max. Negotiated Rate |
$6,828.64 |
| Rate for Payer: Aetna Commercial |
$5,477.14
|
| Rate for Payer: Anthem Medicaid |
$2,446.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,548.27
|
| 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 |
$3,556.58
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cigna Commercial |
$5,903.93
|
| Rate for Payer: First Health Commercial |
$6,757.51
|
| Rate for Payer: Humana Commercial |
$6,046.19
|
| Rate for Payer: Humana KY Medicaid |
$2,446.22
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,471.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,832.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,249.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,495.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,259.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.08
|
| Rate for Payer: PHCS Commercial |
$6,828.64
|
| Rate for Payer: United Healthcare All Payer |
$6,259.59
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Facility
|
OP
|
$5,138.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
761T2085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.96 |
| Max. Negotiated Rate |
$4,932.64 |
| Rate for Payer: Aetna Commercial |
$3,956.39
|
| Rate for Payer: Anthem Medicaid |
$1,767.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,007.77
|
| 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 |
$2,569.08
|
| Rate for Payer: Cash Price |
$2,569.08
|
| Rate for Payer: Cigna Commercial |
$4,264.68
|
| Rate for Payer: First Health Commercial |
$4,881.26
|
| Rate for Payer: Humana Commercial |
$4,367.44
|
| Rate for Payer: Humana KY Medicaid |
$1,767.02
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,213.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,791.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,802.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,521.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,853.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.83
|
| Rate for Payer: PHCS Commercial |
$4,932.64
|
| Rate for Payer: United Healthcare All Payer |
$4,521.59
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Facility
|
IP
|
$5,138.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
761T2085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.96 |
| Max. Negotiated Rate |
$4,932.64 |
| Rate for Payer: Aetna Commercial |
$3,956.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,007.77
|
| Rate for Payer: Cash Price |
$2,569.08
|
| Rate for Payer: Cigna Commercial |
$4,264.68
|
| Rate for Payer: First Health Commercial |
$4,881.26
|
| Rate for Payer: Humana Commercial |
$4,367.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,213.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,791.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,541.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,521.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,853.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.83
|
| Rate for Payer: PHCS Commercial |
$4,932.64
|
| Rate for Payer: United Healthcare All Payer |
$4,521.59
|
|
|
CYSTO W/INSERT URETERAL STEN(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761P2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.22
|
| Rate for Payer: Anthem Medicaid |
$176.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$598.36
|
| Rate for Payer: Humana Medicaid |
$176.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.46
|
| Rate for Payer: Molina Healthcare Passport |
$176.92
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$962.50
|
| Rate for Payer: UHCCP Medicaid |
$127.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.69
|
|
|
CYSTO W/INSERT URETERAL STEN(T
|
Facility
|
OP
|
$5,502.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761T2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.31 |
| Max. Negotiated Rate |
$5,282.29 |
| Rate for Payer: Aetna Commercial |
$4,236.84
|
| Rate for Payer: Anthem Medicaid |
$1,892.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.86
|
| 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 |
$2,751.20
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cigna Commercial |
$4,566.98
|
| Rate for Payer: First Health Commercial |
$5,227.27
|
| Rate for Payer: Humana Commercial |
$4,677.03
|
| Rate for Payer: Humana KY Medicaid |
$1,892.27
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.74
|
| Rate for Payer: PHCS Commercial |
$5,282.29
|
| Rate for Payer: United Healthcare All Payer |
$4,842.10
|
|
|
CYSTO W/INSERT URETERAL STEN(T
|
Facility
|
IP
|
$5,502.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761T2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.31 |
| Max. Negotiated Rate |
$5,282.29 |
| Rate for Payer: Aetna Commercial |
$4,236.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.86
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cigna Commercial |
$4,566.98
|
| Rate for Payer: First Health Commercial |
$5,227.27
|
| Rate for Payer: Humana Commercial |
$4,677.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.74
|
| Rate for Payer: PHCS Commercial |
$5,282.29
|
| Rate for Payer: United Healthcare All Payer |
$4,842.10
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Facility
|
IP
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.06 |
| Max. Negotiated Rate |
$6,602.29 |
| Rate for Payer: Aetna Commercial |
$5,295.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,364.36
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$5,708.23
|
| Rate for Payer: First Health Commercial |
$6,533.52
|
| Rate for Payer: Humana Commercial |
$5,845.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,075.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,063.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,158.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.99
|
| Rate for Payer: PHCS Commercial |
$6,602.29
|
| Rate for Payer: United Healthcare All Payer |
$6,052.10
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$6,877.39 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.22
|
| Rate for Payer: Anthem Medicaid |
$176.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,877.39
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$598.36
|
| Rate for Payer: Humana Medicaid |
$176.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.46
|
| Rate for Payer: Molina Healthcare Passport |
$176.92
|
| Rate for Payer: Multiplan PHCS |
$4,126.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,814.17
|
| Rate for Payer: UHCCP Medicaid |
$127.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.69
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Facility
|
OP
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.06 |
| Max. Negotiated Rate |
$6,602.29 |
| Rate for Payer: Aetna Commercial |
$5,295.59
|
| Rate for Payer: Anthem Medicaid |
$2,365.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,364.36
|
| 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 |
$3,438.70
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$5,708.23
|
| Rate for Payer: First Health Commercial |
$6,533.52
|
| Rate for Payer: Humana Commercial |
$5,845.78
|
| Rate for Payer: Humana KY Medicaid |
$2,365.13
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,389.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,075.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,412.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,158.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,131.99
|
| Rate for Payer: PHCS Commercial |
$6,602.29
|
| Rate for Payer: United Healthcare All Payer |
$6,052.10
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Facility
|
OP
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.82 |
| Max. Negotiated Rate |
$7,405.44 |
| Rate for Payer: Aetna Commercial |
$5,939.78
|
| Rate for Payer: Anthem Medicaid |
$2,652.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.92
|
| 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 |
$3,857.00
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$6,402.62
|
| Rate for Payer: First Health Commercial |
$7,328.30
|
| Rate for Payer: Humana Commercial |
$6,556.90
|
| Rate for Payer: Humana KY Medicaid |
$2,652.84
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,679.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,706.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.34
|
| Rate for Payer: PHCS Commercial |
$7,405.44
|
| Rate for Payer: United Healthcare All Payer |
$6,788.32
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Facility
|
IP
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.82 |
| Max. Negotiated Rate |
$7,405.44 |
| Rate for Payer: Aetna Commercial |
$5,939.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.92
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$6,402.62
|
| Rate for Payer: First Health Commercial |
$7,328.30
|
| Rate for Payer: Humana Commercial |
$6,556.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.34
|
| Rate for Payer: PHCS Commercial |
$7,405.44
|
| Rate for Payer: United Healthcare All Payer |
$6,788.32
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Professional
|
Both
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$7,714.00 |
| Rate for Payer: Aetna Commercial |
$280.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.03
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,714.00
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$249.54
|
| Rate for Payer: Healthspan PPO |
$1,022.78
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$4,628.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,399.80
|
| Rate for Payer: UHCCP Medicaid |
$140.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
|
|
CYSTO W/REMOVAL OF LESIONS S(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761P2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$280.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.03
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$249.54
|
| Rate for Payer: Healthspan PPO |
$1,022.78
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$140.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
|
|
CYSTO W/REMOVAL OF LESIONS S(T
|
Facility
|
OP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761T2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem Medicaid |
$1,965.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| 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 |
$2,857.00
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Humana KY Medicaid |
$1,965.04
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,985.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,004.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,771.34
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
CYSTO W/REMOVAL OF LESIONS S(T
|
Facility
|
IP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761T2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,771.34
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761P2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$410.10
|
| Rate for Payer: Anthem Medicaid |
$273.13
|
| 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 |
$365.21
|
| Rate for Payer: Healthspan PPO |
$327.91
|
| Rate for Payer: Humana Medicaid |
$273.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.59
|
| Rate for Payer: Molina Healthcare Passport |
$273.13
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.86
|
|
