|
CYSTO RX BALO CATH URTL STRX
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 52284
|
| Hospital Charge Code |
76102957
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$6,399.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$6,143.04 |
| Rate for Payer: Aetna Commercial |
$4,927.23
|
| Rate for Payer: Anthem Medicaid |
$2,200.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,991.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cigna Commercial |
$5,311.17
|
| Rate for Payer: First Health Commercial |
$6,079.05
|
| Rate for Payer: Humana Commercial |
$5,439.15
|
| Rate for Payer: Humana KY Medicaid |
$2,200.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,223.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,247.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,722.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,244.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,631.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,799.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,567.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,415.31
|
| Rate for Payer: PHCS Commercial |
$6,143.04
|
| Rate for Payer: United Healthcare All Payer |
$5,631.12
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$6,757.89 |
| Rate for Payer: Aetna Commercial |
$5,420.39
|
| Rate for Payer: Anthem Medicaid |
$2,420.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,490.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$5,842.76
|
| Rate for Payer: First Health Commercial |
$6,687.50
|
| Rate for Payer: Humana Commercial |
$5,983.55
|
| Rate for Payer: Humana KY Medicaid |
$2,420.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,194.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,631.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,124.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,857.23
|
| Rate for Payer: PHCS Commercial |
$6,757.89
|
| Rate for Payer: United Healthcare All Payer |
$6,194.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,399.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,919.70 |
| Max. Negotiated Rate |
$6,143.04 |
| Rate for Payer: Aetna Commercial |
$4,927.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,991.22
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cigna Commercial |
$5,311.17
|
| Rate for Payer: First Health Commercial |
$6,079.05
|
| Rate for Payer: Humana Commercial |
$5,439.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,247.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,722.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,919.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,631.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,799.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,567.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,415.31
|
| Rate for Payer: PHCS Commercial |
$6,143.04
|
| Rate for Payer: United Healthcare All Payer |
$5,631.12
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.05 |
| Max. Negotiated Rate |
$4,223.68 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Ambetter Exchange |
$248.05
|
| Rate for Payer: Anthem Medicaid |
$249.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$393.02
|
| Rate for Payer: Healthspan PPO |
$353.41
|
| Rate for Payer: Humana Medicaid |
$249.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.08
|
| Rate for Payer: Molina Healthcare Passport |
$249.10
|
| Rate for Payer: Multiplan PHCS |
$4,223.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.46
|
| Rate for Payer: UHCCP Medicaid |
$2,463.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,039.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
76102093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,111.84 |
| Max. Negotiated Rate |
$6,757.89 |
| Rate for Payer: Aetna Commercial |
$5,420.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,490.79
|
| Rate for Payer: Cash Price |
$3,519.74
|
| Rate for Payer: Cigna Commercial |
$5,842.76
|
| Rate for Payer: First Health Commercial |
$6,687.50
|
| Rate for Payer: Humana Commercial |
$5,983.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,194.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,631.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,124.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,857.23
|
| Rate for Payer: PHCS Commercial |
$6,757.89
|
| Rate for Payer: United Healthcare All Payer |
$6,194.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$6,399.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
76102094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$3,839.40 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Ambetter Exchange |
$143.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$149.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.65
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cigna Commercial |
$526.81
|
| Rate for Payer: Healthspan PPO |
$386.71
|
| Rate for Payer: Humana Medicaid |
$149.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.70
|
| Rate for Payer: Molina Healthcare Passport |
$149.71
|
| Rate for Payer: Multiplan PHCS |
$3,839.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.95
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.04
|
|
|
CYSTOSCOPY AND TREATMENT(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761P2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Ambetter Exchange |
$143.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$149.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.65
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$526.81
|
| Rate for Payer: Healthspan PPO |
$386.71
|
| Rate for Payer: Humana Medicaid |
$149.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.70
|
| Rate for Payer: Molina Healthcare Passport |
$149.71
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.95
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.04
|
|
|
CYSTOSCOPY AND TREATMENT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761P2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.05 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Ambetter Exchange |
$248.05
|
| Rate for Payer: Anthem Medicaid |
$249.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$297.66
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$393.02
|
| Rate for Payer: Healthspan PPO |
$353.41
|
| Rate for Payer: Humana Medicaid |
$249.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.08
|
| Rate for Payer: Molina Healthcare Passport |
$249.10
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.46
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.05
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
IP
|
$5,449.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761T2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$5,231.04 |
| Rate for Payer: Aetna Commercial |
$4,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,250.22
|
| Rate for Payer: Cash Price |
$2,724.50
|
| Rate for Payer: Cigna Commercial |
$4,522.67
|
| Rate for Payer: First Health Commercial |
$5,176.55
|
| Rate for Payer: Humana Commercial |
$4,631.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,468.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,021.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,795.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,740.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,759.81
|
| Rate for Payer: PHCS Commercial |
$5,231.04
|
| Rate for Payer: United Healthcare All Payer |
$4,795.12
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
IP
|
$5,739.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761T2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,721.84 |
| Max. Negotiated Rate |
$5,509.89 |
| Rate for Payer: Aetna Commercial |
$4,419.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,476.79
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cigna Commercial |
$4,763.76
|
| Rate for Payer: First Health Commercial |
$5,452.50
|
| Rate for Payer: Humana Commercial |
$4,878.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,706.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,235.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,721.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,050.73
|
| Rate for Payer: Ohio Health Group HMO |
$4,304.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,993.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,960.23
|
| Rate for Payer: PHCS Commercial |
$5,509.89
|
| Rate for Payer: United Healthcare All Payer |
$5,050.73
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
OP
|
$5,449.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
761T2094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,873.91 |
| Max. Negotiated Rate |
$5,231.04 |
| Rate for Payer: Aetna Commercial |
$4,195.73
|
| Rate for Payer: Anthem Medicaid |
$1,873.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,250.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,724.50
|
| Rate for Payer: Cash Price |
$2,724.50
|
| Rate for Payer: Cigna Commercial |
$4,522.67
|
| Rate for Payer: First Health Commercial |
$5,176.55
|
| Rate for Payer: Humana Commercial |
$4,631.65
|
| Rate for Payer: Humana KY Medicaid |
$1,873.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,468.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,021.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,795.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,740.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,759.81
|
| Rate for Payer: PHCS Commercial |
$5,231.04
|
| Rate for Payer: United Healthcare All Payer |
$4,795.12
|
|
|
CYSTOSCOPY AND TREATMENT(T
|
Facility
|
OP
|
$5,739.47
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
761T2093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$5,509.89 |
| Rate for Payer: Aetna Commercial |
$4,419.39
|
| Rate for Payer: Anthem Medicaid |
$1,973.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,476.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cash Price |
$2,869.74
|
| Rate for Payer: Cigna Commercial |
$4,763.76
|
| Rate for Payer: First Health Commercial |
$5,452.50
|
| Rate for Payer: Humana Commercial |
$4,878.55
|
| Rate for Payer: Humana KY Medicaid |
$1,973.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,993.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,706.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,235.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,050.73
|
| Rate for Payer: Ohio Health Group HMO |
$4,304.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,993.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,960.23
|
| Rate for Payer: PHCS Commercial |
$5,509.89
|
| Rate for Payer: United Healthcare All Payer |
$5,050.73
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$5,661.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Ambetter Exchange |
$159.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.18
|
| Rate for Payer: Anthem Medicaid |
$245.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$191.27
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cigna Commercial |
$512.83
|
| Rate for Payer: Healthspan PPO |
$282.30
|
| Rate for Payer: Humana Medicaid |
$245.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.95
|
| Rate for Payer: Molina Healthcare Passport |
$245.05
|
| Rate for Payer: Multiplan PHCS |
$3,396.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.21
|
| Rate for Payer: UHCCP Medicaid |
$109.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$247.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.39
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$5,661.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$5,434.56 |
| Rate for Payer: Aetna Commercial |
$4,358.97
|
| Rate for Payer: Anthem Medicaid |
$1,946.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,415.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cigna Commercial |
$4,698.63
|
| Rate for Payer: First Health Commercial |
$5,377.95
|
| Rate for Payer: Humana Commercial |
$4,811.85
|
| Rate for Payer: Humana KY Medicaid |
$1,946.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,966.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,642.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,985.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,981.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,528.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,925.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,906.09
|
| Rate for Payer: PHCS Commercial |
$5,434.56
|
| Rate for Payer: United Healthcare All Payer |
$4,981.68
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$5,661.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
76102783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,698.30 |
| Max. Negotiated Rate |
$5,434.56 |
| Rate for Payer: Aetna Commercial |
$4,358.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,415.58
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cigna Commercial |
$4,698.63
|
| Rate for Payer: First Health Commercial |
$5,377.95
|
| Rate for Payer: Humana Commercial |
$4,811.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,642.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,981.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,528.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,925.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,906.09
|
| Rate for Payer: PHCS Commercial |
$5,434.56
|
| Rate for Payer: United Healthcare All Payer |
$4,981.68
|
|
|
CYSTOSCOPY CHEMODENERVATION (P
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761P2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$512.83 |
| Rate for Payer: Ambetter Exchange |
$159.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.18
|
| Rate for Payer: Anthem Medicaid |
$245.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$191.27
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$512.83
|
| Rate for Payer: Healthspan PPO |
$282.30
|
| Rate for Payer: Humana Medicaid |
$245.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.95
|
| Rate for Payer: Molina Healthcare Passport |
$245.05
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.21
|
| Rate for Payer: UHCCP Medicaid |
$109.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$247.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.39
|
|
|
CYSTOSCOPY CHEMODENERVATION (T
|
Facility
|
IP
|
$5,251.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761T2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,575.30 |
| Max. Negotiated Rate |
$5,040.96 |
| Rate for Payer: Aetna Commercial |
$4,043.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,095.78
|
| Rate for Payer: Cash Price |
$2,625.50
|
| Rate for Payer: Cigna Commercial |
$4,358.33
|
| Rate for Payer: First Health Commercial |
$4,988.45
|
| Rate for Payer: Humana Commercial |
$4,463.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,305.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,620.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,568.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,623.19
|
| Rate for Payer: PHCS Commercial |
$5,040.96
|
| Rate for Payer: United Healthcare All Payer |
$4,620.88
|
|
|
CYSTOSCOPY CHEMODENERVATION (T
|
Facility
|
OP
|
$5,251.00
|
|
|
Service Code
|
HCPCS 52287
|
| Hospital Charge Code |
761T2783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,805.82 |
| Max. Negotiated Rate |
$5,040.96 |
| Rate for Payer: Aetna Commercial |
$4,043.27
|
| Rate for Payer: Anthem Medicaid |
$1,805.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,095.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,625.50
|
| Rate for Payer: Cash Price |
$2,625.50
|
| Rate for Payer: Cigna Commercial |
$4,358.33
|
| Rate for Payer: First Health Commercial |
$4,988.45
|
| Rate for Payer: Humana Commercial |
$4,463.35
|
| Rate for Payer: Humana KY Medicaid |
$1,805.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,824.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,305.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,842.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,620.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,568.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,623.19
|
| Rate for Payer: PHCS Commercial |
$5,040.96
|
| Rate for Payer: United Healthcare All Payer |
$4,620.88
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
OP
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,231.91 |
| Max. Negotiated Rate |
$6,230.40 |
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Anthem Medicaid |
$2,231.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$5,386.70
|
| Rate for Payer: First Health Commercial |
$6,165.50
|
| Rate for Payer: Humana Commercial |
$5,516.50
|
| Rate for Payer: Humana KY Medicaid |
$2,231.91
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,254.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,276.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,646.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,478.10
|
| Rate for Payer: PHCS Commercial |
$6,230.40
|
| Rate for Payer: United Healthcare All Payer |
$5,711.20
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
IP
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,947.00 |
| Max. Negotiated Rate |
$6,230.40 |
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.20
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$5,386.70
|
| Rate for Payer: First Health Commercial |
$6,165.50
|
| Rate for Payer: Humana Commercial |
$5,516.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,646.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,478.10
|
| Rate for Payer: PHCS Commercial |
$6,230.40
|
| Rate for Payer: United Healthcare All Payer |
$5,711.20
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Professional
|
Both
|
$6,490.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
76102095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.59 |
| Max. Negotiated Rate |
$3,894.00 |
| Rate for Payer: Aetna Commercial |
$557.76
|
| Rate for Payer: Ambetter Exchange |
$316.27
|
| Rate for Payer: Anthem Medicaid |
$313.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$316.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$316.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.52
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cash Price |
$3,245.00
|
| Rate for Payer: Cigna Commercial |
$499.55
|
| Rate for Payer: Healthspan PPO |
$445.98
|
| Rate for Payer: Humana Medicaid |
$313.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$316.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.86
|
| Rate for Payer: Molina Healthcare Passport |
$313.59
|
| Rate for Payer: Multiplan PHCS |
$3,894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$411.15
|
| Rate for Payer: UHCCP Medicaid |
$2,271.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$316.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$316.27
|
|
|
CYSTOSCOPY IMPLANT STENT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761P2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.59 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$557.76
|
| Rate for Payer: Ambetter Exchange |
$316.27
|
| Rate for Payer: Anthem Medicaid |
$313.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$316.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$316.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.52
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$499.55
|
| Rate for Payer: Healthspan PPO |
$445.98
|
| Rate for Payer: Humana Medicaid |
$313.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$316.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.86
|
| Rate for Payer: Molina Healthcare Passport |
$313.59
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$411.15
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$316.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$316.27
|
|
|
CYSTOSCOPY IMPLANT STENT(T
|
Facility
|
IP
|
$5,190.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761T2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,557.00 |
| Max. Negotiated Rate |
$4,982.40 |
| Rate for Payer: Aetna Commercial |
$3,996.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.20
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cigna Commercial |
$4,307.70
|
| Rate for Payer: First Health Commercial |
$4,930.50
|
| Rate for Payer: Humana Commercial |
$4,411.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,515.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,581.10
|
| Rate for Payer: PHCS Commercial |
$4,982.40
|
| Rate for Payer: United Healthcare All Payer |
$4,567.20
|
|
|
CYSTOSCOPY IMPLANT STENT(T
|
Facility
|
OP
|
$5,190.00
|
|
|
Service Code
|
HCPCS 52282
|
| Hospital Charge Code |
761T2095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,784.84 |
| Max. Negotiated Rate |
$4,982.40 |
| Rate for Payer: Aetna Commercial |
$3,996.30
|
| Rate for Payer: Anthem Medicaid |
$1,784.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cash Price |
$2,595.00
|
| Rate for Payer: Cigna Commercial |
$4,307.70
|
| Rate for Payer: First Health Commercial |
$4,930.50
|
| Rate for Payer: Humana Commercial |
$4,411.50
|
| Rate for Payer: Humana KY Medicaid |
$1,784.84
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,515.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,581.10
|
| Rate for Payer: PHCS Commercial |
$4,982.40
|
| Rate for Payer: United Healthcare All Payer |
$4,567.20
|
|
