|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
OP
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.45 |
| Max. Negotiated Rate |
$6,804.55 |
| Rate for Payer: Aetna Commercial |
$5,457.81
|
| Rate for Payer: Anthem Medicaid |
$2,437.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.69
|
| 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 |
$3,544.03
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cigna Commercial |
$5,883.10
|
| Rate for Payer: First Health Commercial |
$6,733.67
|
| Rate for Payer: Humana Commercial |
$6,024.86
|
| Rate for Payer: Humana KY Medicaid |
$2,437.59
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,231.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.30
|
| Rate for Payer: PHCS Commercial |
$6,804.55
|
| Rate for Payer: United Healthcare All Payer |
$6,237.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
OP
|
$6,138.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761T2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.95 |
| Max. Negotiated Rate |
$5,892.55 |
| Rate for Payer: Aetna Commercial |
$4,726.31
|
| Rate for Payer: Anthem Medicaid |
$2,110.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,787.69
|
| 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 |
$3,069.03
|
| Rate for Payer: Cash Price |
$3,069.03
|
| Rate for Payer: Cigna Commercial |
$5,094.60
|
| Rate for Payer: First Health Commercial |
$5,831.17
|
| Rate for Payer: Humana Commercial |
$5,217.36
|
| Rate for Payer: Humana KY Medicaid |
$2,110.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,132.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,033.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,153.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,401.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,603.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,902.80
|
| Rate for Payer: PHCS Commercial |
$5,892.55
|
| Rate for Payer: United Healthcare All Payer |
$5,401.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
IP
|
$6,138.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761T2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.95 |
| Max. Negotiated Rate |
$5,892.55 |
| Rate for Payer: Aetna Commercial |
$4,726.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,787.69
|
| Rate for Payer: Cash Price |
$3,069.03
|
| Rate for Payer: Cigna Commercial |
$5,094.60
|
| Rate for Payer: First Health Commercial |
$5,831.17
|
| Rate for Payer: Humana Commercial |
$5,217.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,033.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,841.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,401.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,603.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,902.80
|
| Rate for Payer: PHCS Commercial |
$5,892.55
|
| Rate for Payer: United Healthcare All Payer |
$5,401.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
IP
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.45 |
| Max. Negotiated Rate |
$6,804.55 |
| Rate for Payer: Aetna Commercial |
$5,457.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.69
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cigna Commercial |
$5,883.10
|
| Rate for Payer: First Health Commercial |
$6,733.67
|
| Rate for Payer: Humana Commercial |
$6,024.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,231.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.30
|
| Rate for Payer: PHCS Commercial |
$6,804.55
|
| Rate for Payer: United Healthcare All Payer |
$6,237.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Professional
|
Both
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$7,088.07 |
| Rate for Payer: Aetna Commercial |
$410.10
|
| Rate for Payer: Anthem Medicaid |
$273.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,088.07
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cash Price |
$3,544.03
|
| 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 |
$4,252.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,961.65
|
| Rate for Payer: UHCCP Medicaid |
$2,480.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.86
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 52343
|
| Hospital Charge Code |
76102894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$588.40
|
| Rate for Payer: Anthem Medicaid |
$291.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$573.41
|
| Rate for Payer: Healthspan PPO |
$470.48
|
| Rate for Payer: Humana Medicaid |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.38
|
| Rate for Payer: Molina Healthcare Passport |
$291.55
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.47
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 52343
|
| Hospital Charge Code |
76102894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| 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 |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 52343
|
| Hospital Charge Code |
76102894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
761P2096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: UHCCP Medicaid |
$109.72
|
| Rate for Payer: Aetna Commercial |
$251.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.50
|
| Rate for Payer: Anthem Medicaid |
$169.94
|
| 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 |
$410.50
|
| Rate for Payer: Healthspan PPO |
$321.27
|
| Rate for Payer: Humana Medicaid |
$169.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.34
|
| Rate for Payer: Molina Healthcare Passport |
$169.94
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.64
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
761T2096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.34 |
| Max. Negotiated Rate |
$4,625.28 |
| Rate for Payer: Aetna Commercial |
$3,709.86
|
| Rate for Payer: Anthem Medicaid |
$1,656.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.04
|
| 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 |
$2,409.00
|
| Rate for Payer: Cash Price |
$2,409.00
|
| Rate for Payer: Cigna Commercial |
$3,998.94
|
| Rate for Payer: First Health Commercial |
$4,577.10
|
| Rate for Payer: Humana Commercial |
$4,095.30
|
| Rate for Payer: Humana KY Medicaid |
$1,656.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,673.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,950.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,555.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,690.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,239.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.58
|
| Rate for Payer: PHCS Commercial |
$4,625.28
|
| Rate for Payer: United Healthcare All Payer |
$4,239.84
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Professional
|
Both
|
$5,618.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
76102096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$5,618.00 |
| Rate for Payer: Aetna Commercial |
$251.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.50
|
| Rate for Payer: Anthem Medicaid |
$169.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,618.00
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$410.50
|
| Rate for Payer: Healthspan PPO |
$321.27
|
| Rate for Payer: Humana Medicaid |
$169.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.34
|
| Rate for Payer: Molina Healthcare Passport |
$169.94
|
| Rate for Payer: Multiplan PHCS |
$3,370.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,932.60
|
| Rate for Payer: UHCCP Medicaid |
$109.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.64
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
761T2096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.34 |
| Max. Negotiated Rate |
$4,625.28 |
| Rate for Payer: Aetna Commercial |
$3,709.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.04
|
| Rate for Payer: Cash Price |
$2,409.00
|
| Rate for Payer: Cigna Commercial |
$3,998.94
|
| Rate for Payer: First Health Commercial |
$4,577.10
|
| Rate for Payer: Humana Commercial |
$4,095.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,950.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,555.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,445.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,239.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.58
|
| Rate for Payer: PHCS Commercial |
$4,625.28
|
| Rate for Payer: United Healthcare All Payer |
$4,239.84
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
76102096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem Medicaid |
$1,932.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| 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 |
$2,809.00
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Humana KY Medicaid |
$1,932.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,123.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,741.58
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
CYSTO W/SIMPLE RMV STONE/STENT
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
76102096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,123.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,741.58
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
CYSTO W/TX URETERAL STRICTURE
|
Facility
|
IP
|
$4,998.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
76102104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$4,798.08 |
| Rate for Payer: Aetna Commercial |
$3,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,898.44
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$4,148.34
|
| Rate for Payer: First Health Commercial |
$4,748.10
|
| Rate for Payer: Humana Commercial |
$4,248.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,098.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,688.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,499.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,398.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.38
|
| Rate for Payer: PHCS Commercial |
$4,798.08
|
| Rate for Payer: United Healthcare All Payer |
$4,398.24
|
|
|
CYSTO W/TX URETERAL STRICTURE
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
76102104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$4,798.08 |
| Rate for Payer: Aetna Commercial |
$3,848.46
|
| Rate for Payer: Anthem Medicaid |
$1,718.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,898.44
|
| 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 |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$4,148.34
|
| Rate for Payer: First Health Commercial |
$4,748.10
|
| Rate for Payer: Humana Commercial |
$4,248.30
|
| Rate for Payer: Humana KY Medicaid |
$1,718.81
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,736.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,098.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,688.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,753.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,398.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.38
|
| Rate for Payer: PHCS Commercial |
$4,798.08
|
| Rate for Payer: United Healthcare All Payer |
$4,398.24
|
|
|
CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$4,998.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
76102104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$486.66
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,998.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cigna Commercial |
$483.62
|
| Rate for Payer: Healthspan PPO |
$389.13
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$2,998.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,498.60
|
| Rate for Payer: UHCCP Medicaid |
$1,749.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
CYSTO W/TX URETERAL STRICTUR(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
761P2104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$486.66
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$483.62
|
| Rate for Payer: Healthspan PPO |
$389.13
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
CYSTO W/TX URETERAL STRICTUR(T
|
Facility
|
OP
|
$4,323.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
761T2104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.99 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$3,328.71
|
| Rate for Payer: Anthem Medicaid |
$1,486.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.94
|
| 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 |
$2,161.50
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$3,588.09
|
| Rate for Payer: First Health Commercial |
$4,106.85
|
| Rate for Payer: Humana Commercial |
$3,674.55
|
| Rate for Payer: Humana KY Medicaid |
$1,486.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,501.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,190.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,516.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,804.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.13
|
| Rate for Payer: PHCS Commercial |
$4,150.08
|
| Rate for Payer: United Healthcare All Payer |
$3,804.24
|
|
|
CYSTO W/TX URETERAL STRICTUR(T
|
Facility
|
IP
|
$4,323.00
|
|
|
Service Code
|
HCPCS 52341
|
| Hospital Charge Code |
761T2104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.99 |
| Max. Negotiated Rate |
$4,150.08 |
| Rate for Payer: Aetna Commercial |
$3,328.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.94
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$3,588.09
|
| Rate for Payer: First Health Commercial |
$4,106.85
|
| Rate for Payer: Humana Commercial |
$3,674.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,190.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,804.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.13
|
| Rate for Payer: PHCS Commercial |
$4,150.08
|
| Rate for Payer: United Healthcare All Payer |
$3,804.24
|
|
|
CYSTO W/URETEROSCOPY W/LITHO(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
761P2108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$706.19
|
| Rate for Payer: Anthem Medicaid |
$353.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$628.17
|
| Rate for Payer: Healthspan PPO |
$564.66
|
| Rate for Payer: Humana Medicaid |
$353.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.50
|
| Rate for Payer: Molina Healthcare Passport |
$353.43
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.96
|
|
|
CYSTO W/URETEROSCOPY W/LITHO(T
|
Facility
|
OP
|
$8,131.40
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
761T2108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,057.08 |
| Max. Negotiated Rate |
$7,806.14 |
| Rate for Payer: Aetna Commercial |
$6,261.18
|
| Rate for Payer: Anthem Medicaid |
$2,796.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,342.49
|
| 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 |
$4,065.70
|
| Rate for Payer: Cash Price |
$4,065.70
|
| Rate for Payer: Cigna Commercial |
$6,749.06
|
| Rate for Payer: First Health Commercial |
$7,724.83
|
| Rate for Payer: Humana Commercial |
$6,911.69
|
| Rate for Payer: Humana KY Medicaid |
$2,796.39
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,667.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,155.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,098.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.73
|
| Rate for Payer: PHCS Commercial |
$7,806.14
|
| Rate for Payer: United Healthcare All Payer |
$7,155.63
|
|
|
CYSTO W/URETEROSCOPY W/LITHO(T
|
Facility
|
IP
|
$8,131.40
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
761T2108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,057.08 |
| Max. Negotiated Rate |
$7,806.14 |
| Rate for Payer: Aetna Commercial |
$6,261.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,342.49
|
| Rate for Payer: Cash Price |
$4,065.70
|
| Rate for Payer: Cigna Commercial |
$6,749.06
|
| Rate for Payer: First Health Commercial |
$7,724.83
|
| Rate for Payer: Humana Commercial |
$6,911.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,667.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,000.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,155.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,098.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.73
|
| Rate for Payer: PHCS Commercial |
$7,806.14
|
| Rate for Payer: United Healthcare All Payer |
$7,155.63
|
|
|
CYSTO W/URETEROSCOPY W/LITHOT
|
Facility
|
IP
|
$9,106.40
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
76102108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,183.83 |
| Max. Negotiated Rate |
$8,742.14 |
| Rate for Payer: Aetna Commercial |
$7,011.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,102.99
|
| Rate for Payer: Cash Price |
$4,553.20
|
| Rate for Payer: Cigna Commercial |
$7,558.31
|
| Rate for Payer: First Health Commercial |
$8,651.08
|
| Rate for Payer: Humana Commercial |
$7,740.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,467.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,720.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,731.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,013.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,829.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,822.98
|
| Rate for Payer: PHCS Commercial |
$8,742.14
|
| Rate for Payer: United Healthcare All Payer |
$8,013.63
|
|
|
CYSTO W/URETEROSCOPY W/LITHOT
|
Professional
|
Both
|
$9,106.40
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
76102108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$9,106.40 |
| Rate for Payer: Aetna Commercial |
$706.19
|
| Rate for Payer: Anthem Medicaid |
$353.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,106.40
|
| Rate for Payer: Cash Price |
$4,553.20
|
| Rate for Payer: Cash Price |
$4,553.20
|
| Rate for Payer: Cigna Commercial |
$628.17
|
| Rate for Payer: Healthspan PPO |
$564.66
|
| Rate for Payer: Humana Medicaid |
$353.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.50
|
| Rate for Payer: Molina Healthcare Passport |
$353.43
|
| Rate for Payer: Multiplan PHCS |
$5,463.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,374.48
|
| Rate for Payer: UHCCP Medicaid |
$3,187.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.96
|
|
