|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Facility
|
IP
|
$8,470.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
76102088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,101.10 |
| Max. Negotiated Rate |
$8,131.20 |
| Rate for Payer: Aetna Commercial |
$6,521.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,606.60
|
| Rate for Payer: Cash Price |
$4,235.00
|
| Rate for Payer: Cigna Commercial |
$7,030.10
|
| Rate for Payer: First Health Commercial |
$8,046.50
|
| Rate for Payer: Humana Commercial |
$7,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,250.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,453.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,625.70
|
| Rate for Payer: PHCS Commercial |
$8,131.20
|
| Rate for Payer: United Healthcare All Payer |
$7,453.60
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
761P2088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.55 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$480.98
|
| Rate for Payer: Anthem Medicaid |
$366.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$428.27
|
| Rate for Payer: Healthspan PPO |
$384.59
|
| Rate for Payer: Humana Medicaid |
$366.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$395.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.88
|
| Rate for Payer: Molina Healthcare Passport |
$366.55
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.22
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Professional
|
Both
|
$8,470.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
76102088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.55 |
| Max. Negotiated Rate |
$8,470.00 |
| Rate for Payer: Aetna Commercial |
$480.98
|
| Rate for Payer: Anthem Medicaid |
$366.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,470.00
|
| Rate for Payer: Cash Price |
$4,235.00
|
| Rate for Payer: Cash Price |
$4,235.00
|
| Rate for Payer: Cigna Commercial |
$428.27
|
| Rate for Payer: Healthspan PPO |
$384.59
|
| Rate for Payer: Humana Medicaid |
$366.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$395.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.88
|
| Rate for Payer: Molina Healthcare Passport |
$366.55
|
| Rate for Payer: Multiplan PHCS |
$5,082.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,929.00
|
| Rate for Payer: UHCCP Medicaid |
$2,964.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.22
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Facility
|
OP
|
$8,470.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
76102088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,101.10 |
| Max. Negotiated Rate |
$8,131.20 |
| Rate for Payer: Aetna Commercial |
$6,521.90
|
| Rate for Payer: Anthem Medicaid |
$2,912.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,606.60
|
| 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 |
$4,235.00
|
| Rate for Payer: Cash Price |
$4,235.00
|
| Rate for Payer: Cigna Commercial |
$7,030.10
|
| Rate for Payer: First Health Commercial |
$8,046.50
|
| Rate for Payer: Humana Commercial |
$7,199.50
|
| Rate for Payer: Humana KY Medicaid |
$2,912.83
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,250.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,453.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,625.70
|
| Rate for Payer: PHCS Commercial |
$8,131.20
|
| Rate for Payer: United Healthcare All Payer |
$7,453.60
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Facility
|
IP
|
$6,770.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
761T2088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.10 |
| Max. Negotiated Rate |
$6,499.20 |
| Rate for Payer: Aetna Commercial |
$5,212.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,280.60
|
| Rate for Payer: Cash Price |
$3,385.00
|
| Rate for Payer: Cigna Commercial |
$5,619.10
|
| Rate for Payer: First Health Commercial |
$6,431.50
|
| Rate for Payer: Humana Commercial |
$5,754.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,551.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,996.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,031.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,957.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,077.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,098.70
|
| Rate for Payer: PHCS Commercial |
$6,499.20
|
| Rate for Payer: United Healthcare All Payer |
$5,957.60
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM MD
|
Facility
|
OP
|
$6,770.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
761T2088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.10 |
| Max. Negotiated Rate |
$6,499.20 |
| Rate for Payer: Aetna Commercial |
$5,212.90
|
| Rate for Payer: Anthem Medicaid |
$2,328.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,280.60
|
| 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 |
$3,385.00
|
| Rate for Payer: Cash Price |
$3,385.00
|
| Rate for Payer: Cigna Commercial |
$5,619.10
|
| Rate for Payer: First Health Commercial |
$6,431.50
|
| Rate for Payer: Humana Commercial |
$5,754.50
|
| Rate for Payer: Humana KY Medicaid |
$2,328.20
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,551.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,996.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,374.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,957.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,077.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$880.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,098.70
|
| Rate for Payer: PHCS Commercial |
$6,499.20
|
| Rate for Payer: United Healthcare All Payer |
$5,957.60
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Facility
|
OP
|
$5,324.17
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
76102090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.14 |
| Max. Negotiated Rate |
$5,111.20 |
| Rate for Payer: Aetna Commercial |
$4,099.61
|
| Rate for Payer: Anthem Medicaid |
$1,830.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,152.85
|
| 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 |
$2,662.08
|
| Rate for Payer: Cash Price |
$2,662.08
|
| Rate for Payer: Cigna Commercial |
$4,419.06
|
| Rate for Payer: First Health Commercial |
$5,057.96
|
| Rate for Payer: Humana Commercial |
$4,525.54
|
| Rate for Payer: Humana KY Medicaid |
$1,830.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,849.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,365.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,929.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,867.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,685.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,993.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.49
|
| Rate for Payer: PHCS Commercial |
$5,111.20
|
| Rate for Payer: United Healthcare All Payer |
$4,685.27
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Professional
|
Both
|
$5,324.17
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
76102090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.97 |
| Max. Negotiated Rate |
$5,324.17 |
| Rate for Payer: Aetna Commercial |
$347.36
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,324.17
|
| Rate for Payer: Cash Price |
$2,662.08
|
| Rate for Payer: Cash Price |
$2,662.08
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: Healthspan PPO |
$277.75
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$3,194.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,726.92
|
| Rate for Payer: UHCCP Medicaid |
$1,863.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Facility
|
IP
|
$5,324.17
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
76102090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.14 |
| Max. Negotiated Rate |
$5,111.20 |
| Rate for Payer: Aetna Commercial |
$4,099.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,152.85
|
| Rate for Payer: Cash Price |
$2,662.08
|
| Rate for Payer: Cigna Commercial |
$4,419.06
|
| Rate for Payer: First Health Commercial |
$5,057.96
|
| Rate for Payer: Humana Commercial |
$4,525.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,365.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,929.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,685.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,993.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.49
|
| Rate for Payer: PHCS Commercial |
$5,111.20
|
| Rate for Payer: United Healthcare All Payer |
$4,685.27
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Facility
|
OP
|
$4,749.17
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
761T2090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.39 |
| Max. Negotiated Rate |
$4,559.20 |
| Rate for Payer: Aetna Commercial |
$3,656.86
|
| Rate for Payer: Anthem Medicaid |
$1,633.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.35
|
| 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 |
$2,374.58
|
| Rate for Payer: Cash Price |
$2,374.58
|
| Rate for Payer: Cigna Commercial |
$3,941.81
|
| Rate for Payer: First Health Commercial |
$4,511.71
|
| Rate for Payer: Humana Commercial |
$4,036.79
|
| Rate for Payer: Humana KY Medicaid |
$1,633.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.24
|
| Rate for Payer: PHCS Commercial |
$4,559.20
|
| Rate for Payer: United Healthcare All Payer |
$4,179.27
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
761P2090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.97 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$347.36
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: Healthspan PPO |
$277.75
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
|
|
CYSTRTHRSCPY WDIL BLD W/ANESTH
|
Facility
|
IP
|
$4,749.17
|
|
|
Service Code
|
HCPCS 52260
|
| Hospital Charge Code |
761T2090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.39 |
| Max. Negotiated Rate |
$4,559.20 |
| Rate for Payer: Aetna Commercial |
$3,656.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.35
|
| Rate for Payer: Cash Price |
$2,374.58
|
| Rate for Payer: Cigna Commercial |
$3,941.81
|
| Rate for Payer: First Health Commercial |
$4,511.71
|
| Rate for Payer: Humana Commercial |
$4,036.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.24
|
| Rate for Payer: PHCS Commercial |
$4,559.20
|
| Rate for Payer: United Healthcare All Payer |
$4,179.27
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC
|
Professional
|
Both
|
$6,377.53
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
76102100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.69 |
| Max. Negotiated Rate |
$6,377.53 |
| Rate for Payer: Aetna Commercial |
$410.93
|
| Rate for Payer: Anthem Medicaid |
$279.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,377.53
|
| Rate for Payer: Cash Price |
$3,188.76
|
| Rate for Payer: Cash Price |
$3,188.76
|
| Rate for Payer: Cigna Commercial |
$366.57
|
| Rate for Payer: Healthspan PPO |
$328.58
|
| Rate for Payer: Humana Medicaid |
$279.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.28
|
| Rate for Payer: Molina Healthcare Passport |
$279.69
|
| Rate for Payer: Multiplan PHCS |
$3,826.52
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,464.27
|
| Rate for Payer: UHCCP Medicaid |
$2,232.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.49
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC
|
Facility
|
OP
|
$6,377.53
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
76102100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$6,122.43 |
| Rate for Payer: Aetna Commercial |
$4,910.70
|
| Rate for Payer: Anthem Medicaid |
$2,193.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,974.47
|
| 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 |
$3,188.76
|
| Rate for Payer: Cash Price |
$3,188.76
|
| Rate for Payer: Cigna Commercial |
$5,293.35
|
| Rate for Payer: First Health Commercial |
$6,058.65
|
| Rate for Payer: Humana Commercial |
$5,420.90
|
| Rate for Payer: Humana KY Medicaid |
$2,193.23
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,215.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,237.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,612.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,783.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,275.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$829.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,977.03
|
| Rate for Payer: PHCS Commercial |
$6,122.43
|
| Rate for Payer: United Healthcare All Payer |
$5,612.23
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC
|
Facility
|
IP
|
$6,377.53
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
76102100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$6,122.43 |
| Rate for Payer: Aetna Commercial |
$4,910.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,974.47
|
| Rate for Payer: Cash Price |
$3,188.76
|
| Rate for Payer: Cigna Commercial |
$5,293.35
|
| Rate for Payer: First Health Commercial |
$6,058.65
|
| Rate for Payer: Humana Commercial |
$5,420.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,913.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,612.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,783.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,275.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$829.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,977.03
|
| Rate for Payer: PHCS Commercial |
$6,122.43
|
| Rate for Payer: United Healthcare All Payer |
$5,612.23
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
761P2100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.69 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$410.93
|
| Rate for Payer: Anthem Medicaid |
$279.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$366.57
|
| Rate for Payer: Healthspan PPO |
$328.58
|
| Rate for Payer: Humana Medicaid |
$279.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.28
|
| Rate for Payer: Molina Healthcare Passport |
$279.69
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.49
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC(T
|
Facility
|
OP
|
$5,137.53
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
761T2100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.88 |
| Max. Negotiated Rate |
$4,932.03 |
| Rate for Payer: Aetna Commercial |
$3,955.90
|
| Rate for Payer: Anthem Medicaid |
$1,766.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,007.27
|
| 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 |
$2,568.76
|
| Rate for Payer: Cash Price |
$2,568.76
|
| Rate for Payer: Cigna Commercial |
$4,264.15
|
| Rate for Payer: First Health Commercial |
$4,880.65
|
| Rate for Payer: Humana Commercial |
$4,366.90
|
| Rate for Payer: Humana KY Medicaid |
$1,766.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,212.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,802.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,521.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,853.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.63
|
| Rate for Payer: PHCS Commercial |
$4,932.03
|
| Rate for Payer: United Healthcare All Payer |
$4,521.03
|
|
|
CYSTRTHRSCPY W/RMVL URT CALC(T
|
Facility
|
IP
|
$5,137.53
|
|
|
Service Code
|
HCPCS 52320
|
| Hospital Charge Code |
761T2100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.88 |
| Max. Negotiated Rate |
$4,932.03 |
| Rate for Payer: Aetna Commercial |
$3,955.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,007.27
|
| Rate for Payer: Cash Price |
$2,568.76
|
| Rate for Payer: Cigna Commercial |
$4,264.15
|
| Rate for Payer: First Health Commercial |
$4,880.65
|
| Rate for Payer: Humana Commercial |
$4,366.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,212.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,541.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,521.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,853.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.63
|
| Rate for Payer: PHCS Commercial |
$4,932.03
|
| Rate for Payer: United Healthcare All Payer |
$4,521.03
|
|
|
CYTARABINE 100MG [2MG/20ML] VL
|
Facility
|
IP
|
$113.91
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
25002589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Aetna Commercial |
$87.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.85
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cigna Commercial |
$94.55
|
| Rate for Payer: First Health Commercial |
$108.21
|
| Rate for Payer: Humana Commercial |
$96.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.24
|
| Rate for Payer: Ohio Health Group HMO |
$85.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.31
|
| Rate for Payer: PHCS Commercial |
$109.35
|
| Rate for Payer: United Healthcare All Payer |
$100.24
|
|
|
CYTARABINE 100MG [2MG/20ML] VL
|
Facility
|
OP
|
$113.91
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
25002589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Anthem Medicaid |
$39.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.85
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cigna Commercial |
$94.55
|
| Rate for Payer: First Health Commercial |
$108.21
|
| Rate for Payer: Humana Commercial |
$96.82
|
| Rate for Payer: Humana KY Medicaid |
$39.17
|
| Rate for Payer: Kentucky WC Medicaid |
$39.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.24
|
| Rate for Payer: Ohio Health Group HMO |
$85.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.31
|
| Rate for Payer: PHCS Commercial |
$109.35
|
| Rate for Payer: United Healthcare All Payer |
$100.24
|
| Rate for Payer: Aetna Commercial |
$87.71
|
|
|
CYTOL CELL BLK
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001506
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
CYTOL CELL BLK
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
30001506
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$88.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Humana KY Medicaid |
$88.04
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$88.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
CYTOMEGALOVIRUS PCR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001369
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.90
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CYTOMEGALOVIRUS PCR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001369
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CYTOMEL(LIOTHYRONI) 5 MCG TAB
|
Facility
|
IP
|
$9.06
|
|
|
Service Code
|
NDC 51862032001
|
| Hospital Charge Code |
25000506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.52
|
| Rate for Payer: First Health Commercial |
$8.61
|
| Rate for Payer: Humana Commercial |
$7.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.97
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Payer |
$7.97
|
|
