|
CYSTO W/URETEROSCOPY W/LITHOT
|
Facility
|
OP
|
$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 Medicaid |
$3,131.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,102.99
|
| 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 |
$4,553.20
|
| 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: Humana KY Medicaid |
$3,131.69
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.56
|
| 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 |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.53
|
| 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/URTROSCOP/PYELOSCOP DX
|
Facility
|
IP
|
$5,618.67
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
76102106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.43 |
| Max. Negotiated Rate |
$5,393.92 |
| Rate for Payer: Aetna Commercial |
$4,326.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.56
|
| Rate for Payer: Cash Price |
$2,809.34
|
| Rate for Payer: Cigna Commercial |
$4,663.50
|
| Rate for Payer: First Health Commercial |
$5,337.74
|
| Rate for Payer: Humana Commercial |
$4,775.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,607.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,944.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,214.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,123.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,741.79
|
| Rate for Payer: PHCS Commercial |
$5,393.92
|
| Rate for Payer: United Healthcare All Payer |
$4,944.43
|
|
|
CYSTO W/URTROSCOP/PYELOSCOP DX
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
761P2106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.37 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$522.14
|
| Rate for Payer: Anthem Medicaid |
$247.37
|
| 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 |
$463.92
|
| Rate for Payer: Healthspan PPO |
$417.50
|
| Rate for Payer: Humana Medicaid |
$247.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$429.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.32
|
| Rate for Payer: Molina Healthcare Passport |
$247.37
|
| 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 |
$249.84
|
|
|
CYSTO W/URTROSCOP/PYELOSCOP DX
|
Facility
|
OP
|
$5,618.67
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
76102106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.43 |
| Max. Negotiated Rate |
$5,393.92 |
| Rate for Payer: Aetna Commercial |
$4,326.38
|
| Rate for Payer: Anthem Medicaid |
$1,932.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.56
|
| 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 |
$2,809.34
|
| Rate for Payer: Cash Price |
$2,809.34
|
| Rate for Payer: Cigna Commercial |
$4,663.50
|
| Rate for Payer: First Health Commercial |
$5,337.74
|
| Rate for Payer: Humana Commercial |
$4,775.87
|
| Rate for Payer: Humana KY Medicaid |
$1,932.26
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,607.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,944.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,214.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,123.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,741.79
|
| Rate for Payer: PHCS Commercial |
$5,393.92
|
| Rate for Payer: United Healthcare All Payer |
$4,944.43
|
|
|
CYSTO W/URTROSCOP/PYELOSCOP DX
|
Facility
|
OP
|
$4,818.67
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
761T2106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.43 |
| Max. Negotiated Rate |
$4,625.92 |
| Rate for Payer: Aetna Commercial |
$3,710.38
|
| Rate for Payer: Anthem Medicaid |
$1,657.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.56
|
| 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 |
$2,409.34
|
| Rate for Payer: Cash Price |
$2,409.34
|
| Rate for Payer: Cigna Commercial |
$3,999.50
|
| Rate for Payer: First Health Commercial |
$4,577.74
|
| Rate for Payer: Humana Commercial |
$4,095.87
|
| Rate for Payer: Humana KY Medicaid |
$1,657.14
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,674.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,951.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,556.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,690.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,240.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.79
|
| Rate for Payer: PHCS Commercial |
$4,625.92
|
| Rate for Payer: United Healthcare All Payer |
$4,240.43
|
|
|
CYSTO W/URTROSCOP/PYELOSCOP DX
|
Professional
|
Both
|
$5,618.67
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
76102106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.37 |
| Max. Negotiated Rate |
$5,618.67 |
| Rate for Payer: Aetna Commercial |
$522.14
|
| Rate for Payer: Anthem Medicaid |
$247.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,618.67
|
| Rate for Payer: Cash Price |
$2,809.34
|
| Rate for Payer: Cash Price |
$2,809.34
|
| Rate for Payer: Cigna Commercial |
$463.92
|
| Rate for Payer: Healthspan PPO |
$417.50
|
| Rate for Payer: Humana Medicaid |
$247.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$429.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.32
|
| Rate for Payer: Molina Healthcare Passport |
$247.37
|
| Rate for Payer: Multiplan PHCS |
$3,371.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,933.07
|
| Rate for Payer: UHCCP Medicaid |
$1,966.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.84
|
|
|
CYSTO W/URTROSCOP/PYELOSCOP DX
|
Facility
|
IP
|
$4,818.67
|
|
|
Service Code
|
HCPCS 52351
|
| Hospital Charge Code |
761T2106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.43 |
| Max. Negotiated Rate |
$4,625.92 |
| Rate for Payer: Aetna Commercial |
$3,710.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.56
|
| Rate for Payer: Cash Price |
$2,409.34
|
| Rate for Payer: Cigna Commercial |
$3,999.50
|
| Rate for Payer: First Health Commercial |
$4,577.74
|
| Rate for Payer: Humana Commercial |
$4,095.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,951.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,556.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,445.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,240.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,614.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.79
|
| Rate for Payer: PHCS Commercial |
$4,625.92
|
| Rate for Payer: United Healthcare All Payer |
$4,240.43
|
|
|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.07 |
| Max. Negotiated Rate |
$6,523.00 |
| Rate for Payer: Aetna Commercial |
$613.47
|
| Rate for Payer: Anthem Medicaid |
$305.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,523.00
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$545.40
|
| Rate for Payer: Healthspan PPO |
$490.52
|
| Rate for Payer: Humana Medicaid |
$305.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$505.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.17
|
| Rate for Payer: Molina Healthcare Passport |
$305.07
|
| Rate for Payer: Multiplan PHCS |
$3,913.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,566.10
|
| Rate for Payer: UHCCP Medicaid |
$2,283.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.12
|
|
|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Facility
|
IP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$847.99 |
| Max. Negotiated Rate |
$6,262.08 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,956.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.13
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Facility
|
OP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$847.99 |
| Max. Negotiated Rate |
$6,262.08 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem Medicaid |
$2,243.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| 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 |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Humana KY Medicaid |
$2,243.26
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.13
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761P2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.07 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$613.47
|
| Rate for Payer: Anthem Medicaid |
$305.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$545.40
|
| Rate for Payer: Healthspan PPO |
$490.52
|
| Rate for Payer: Humana Medicaid |
$305.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$505.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.17
|
| Rate for Payer: Molina Healthcare Passport |
$305.07
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.12
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(T
|
Facility
|
OP
|
$5,623.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761T2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.99 |
| Max. Negotiated Rate |
$5,398.08 |
| Rate for Payer: Aetna Commercial |
$4,329.71
|
| Rate for Payer: Anthem Medicaid |
$1,933.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.94
|
| 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 |
$2,811.50
|
| Rate for Payer: Cash Price |
$2,811.50
|
| Rate for Payer: Cigna Commercial |
$4,667.09
|
| Rate for Payer: First Health Commercial |
$5,341.85
|
| Rate for Payer: Humana Commercial |
$4,779.55
|
| Rate for Payer: Humana KY Medicaid |
$1,933.75
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,953.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,972.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,948.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,217.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,743.13
|
| Rate for Payer: PHCS Commercial |
$5,398.08
|
| Rate for Payer: United Healthcare All Payer |
$4,948.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(T
|
Facility
|
IP
|
$5,623.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761T2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.99 |
| Max. Negotiated Rate |
$5,398.08 |
| Rate for Payer: Aetna Commercial |
$4,329.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.94
|
| Rate for Payer: Cash Price |
$2,811.50
|
| Rate for Payer: Cigna Commercial |
$4,667.09
|
| Rate for Payer: First Health Commercial |
$5,341.85
|
| Rate for Payer: Humana Commercial |
$4,779.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,948.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,217.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,743.13
|
| Rate for Payer: PHCS Commercial |
$5,398.08
|
| Rate for Payer: United Healthcare All Payer |
$4,948.24
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$4,214.00 |
| Rate for Payer: Aetna Commercial |
$261.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.33
|
| Rate for Payer: Anthem Medicaid |
$107.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,214.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$826.17
|
| Rate for Payer: Healthspan PPO |
$528.69
|
| Rate for Payer: Humana Medicaid |
$107.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.94
|
| Rate for Payer: Molina Healthcare Passport |
$107.78
|
| Rate for Payer: Multiplan PHCS |
$2,528.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,949.80
|
| Rate for Payer: UHCCP Medicaid |
$110.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.86
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem Medicaid |
$1,449.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| 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 |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Humana KY Medicaid |
$1,449.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.34
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.34
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761P2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$826.17 |
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.50
|
| Rate for Payer: Aetna Commercial |
$261.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.33
|
| Rate for Payer: Anthem Medicaid |
$107.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$826.17
|
| Rate for Payer: Healthspan PPO |
$528.69
|
| Rate for Payer: Humana Medicaid |
$107.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.94
|
| Rate for Payer: Molina Healthcare Passport |
$107.78
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$110.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.86
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(T
|
Facility
|
OP
|
$3,849.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761T2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.37 |
| Max. Negotiated Rate |
$3,695.04 |
| Rate for Payer: Aetna Commercial |
$2,963.73
|
| Rate for Payer: Anthem Medicaid |
$1,323.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,002.22
|
| 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 |
$1,924.50
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$3,194.67
|
| Rate for Payer: First Health Commercial |
$3,656.55
|
| Rate for Payer: Humana Commercial |
$3,271.65
|
| Rate for Payer: Humana KY Medicaid |
$1,323.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,337.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,156.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,840.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,350.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,387.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,886.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.19
|
| Rate for Payer: PHCS Commercial |
$3,695.04
|
| Rate for Payer: United Healthcare All Payer |
$3,387.12
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(T
|
Facility
|
IP
|
$3,849.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761T2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.37 |
| Max. Negotiated Rate |
$3,695.04 |
| Rate for Payer: Aetna Commercial |
$2,963.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,002.22
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$3,194.67
|
| Rate for Payer: First Health Commercial |
$3,656.55
|
| Rate for Payer: Humana Commercial |
$3,271.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,156.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,840.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,387.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,886.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.19
|
| Rate for Payer: PHCS Commercial |
$3,695.04
|
| Rate for Payer: United Healthcare All Payer |
$3,387.12
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761P2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$596.14 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$841.98
|
| Rate for Payer: Anthem Medicaid |
$596.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$753.02
|
| Rate for Payer: Healthspan PPO |
$673.24
|
| Rate for Payer: Humana Medicaid |
$596.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.06
|
| Rate for Payer: Molina Healthcare Passport |
$596.14
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.10
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
OP
|
$8,092.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761T2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.97 |
| Max. Negotiated Rate |
$7,768.42 |
| Rate for Payer: Aetna Commercial |
$6,230.92
|
| Rate for Payer: Anthem Medicaid |
$2,782.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.84
|
| 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 |
$4,046.05
|
| Rate for Payer: Cash Price |
$4,046.05
|
| Rate for Payer: Cigna Commercial |
$6,716.44
|
| Rate for Payer: First Health Commercial |
$7,687.50
|
| Rate for Payer: Humana Commercial |
$6,878.28
|
| Rate for Payer: Humana KY Medicaid |
$2,782.87
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.55
|
| Rate for Payer: PHCS Commercial |
$7,768.42
|
| Rate for Payer: United Healthcare All Payer |
$7,121.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
OP
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,373.72 |
| Max. Negotiated Rate |
$10,144.42 |
| Rate for Payer: Aetna Commercial |
$8,136.67
|
| Rate for Payer: Anthem Medicaid |
$3,634.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,242.34
|
| 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 |
$5,283.55
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$8,770.69
|
| Rate for Payer: First Health Commercial |
$10,038.74
|
| Rate for Payer: Humana Commercial |
$8,982.04
|
| Rate for Payer: Humana KY Medicaid |
$3,634.03
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,671.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,798.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,299.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,925.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,373.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,275.80
|
| Rate for Payer: PHCS Commercial |
$10,144.42
|
| Rate for Payer: United Healthcare All Payer |
$9,299.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
IP
|
$8,092.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761T2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.97 |
| Max. Negotiated Rate |
$7,768.42 |
| Rate for Payer: Aetna Commercial |
$6,230.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.84
|
| Rate for Payer: Cash Price |
$4,046.05
|
| Rate for Payer: Cigna Commercial |
$6,716.44
|
| Rate for Payer: First Health Commercial |
$7,687.50
|
| Rate for Payer: Humana Commercial |
$6,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.55
|
| Rate for Payer: PHCS Commercial |
$7,768.42
|
| Rate for Payer: United Healthcare All Payer |
$7,121.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Professional
|
Both
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$596.14 |
| Max. Negotiated Rate |
$10,567.10 |
| Rate for Payer: Aetna Commercial |
$841.98
|
| Rate for Payer: Anthem Medicaid |
$596.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$10,567.10
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$753.02
|
| Rate for Payer: Healthspan PPO |
$673.24
|
| Rate for Payer: Humana Medicaid |
$596.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.06
|
| Rate for Payer: Molina Healthcare Passport |
$596.14
|
| Rate for Payer: Multiplan PHCS |
$6,340.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,396.97
|
| Rate for Payer: UHCCP Medicaid |
$3,698.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.10
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
IP
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,373.72 |
| Max. Negotiated Rate |
$10,144.42 |
| Rate for Payer: Aetna Commercial |
$8,136.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,242.34
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$8,770.69
|
| Rate for Payer: First Health Commercial |
$10,038.74
|
| Rate for Payer: Humana Commercial |
$8,982.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,798.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,170.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,299.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,925.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,373.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,275.80
|
| Rate for Payer: PHCS Commercial |
$10,144.42
|
| Rate for Payer: United Healthcare All Payer |
$9,299.05
|
|
