|
CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$7,113.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
76102085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$4,267.90 |
| Rate for Payer: Aetna Commercial |
$358.42
|
| Rate for Payer: Ambetter Exchange |
$165.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.44
|
| Rate for Payer: Anthem Medicaid |
$190.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.00
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cigna Commercial |
$292.39
|
| Rate for Payer: Healthspan PPO |
$723.97
|
| Rate for Payer: Humana Medicaid |
$190.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.59
|
| Rate for Payer: Molina Healthcare Passport |
$190.77
|
| Rate for Payer: Multiplan PHCS |
$4,267.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.50
|
| Rate for Payer: UHCCP Medicaid |
$144.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.00
|
|
|
CYSTO W/DESTRUCTION OF LESIONS
|
Facility
|
IP
|
$7,113.17
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
76102085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,133.95 |
| Max. Negotiated Rate |
$6,828.64 |
| Rate for Payer: Aetna Commercial |
$5,477.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,548.27
|
| Rate for Payer: Cash Price |
$3,556.58
|
| Rate for Payer: Cigna Commercial |
$5,903.93
|
| Rate for Payer: First Health Commercial |
$6,757.51
|
| Rate for Payer: Humana Commercial |
$6,046.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,832.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,249.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,259.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,690.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,188.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,908.09
|
| Rate for Payer: PHCS Commercial |
$6,828.64
|
| Rate for Payer: United Healthcare All Payer |
$6,259.59
|
|
|
CYSTO W/INSERT URETERAL STEN(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761P2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Ambetter Exchange |
$146.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.22
|
| Rate for Payer: Anthem Medicaid |
$176.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.48
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$598.36
|
| Rate for Payer: Humana Medicaid |
$176.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.46
|
| Rate for Payer: Molina Healthcare Passport |
$176.92
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.10
|
| Rate for Payer: UHCCP Medicaid |
$127.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.23
|
|
|
CYSTO W/INSERT URETERAL STEN(T
|
Facility
|
IP
|
$5,502.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761T2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.72 |
| Max. Negotiated Rate |
$5,282.29 |
| Rate for Payer: Aetna Commercial |
$4,236.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.86
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cigna Commercial |
$4,566.98
|
| Rate for Payer: First Health Commercial |
$5,227.27
|
| Rate for Payer: Humana Commercial |
$4,677.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.65
|
| Rate for Payer: PHCS Commercial |
$5,282.29
|
| Rate for Payer: United Healthcare All Payer |
$4,842.10
|
|
|
CYSTO W/INSERT URETERAL STEN(T
|
Facility
|
OP
|
$5,502.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
761T2103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.27 |
| Max. Negotiated Rate |
$5,282.29 |
| Rate for Payer: Aetna Commercial |
$4,236.84
|
| Rate for Payer: Anthem Medicaid |
$1,892.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.86
|
| 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 |
$2,751.20
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cigna Commercial |
$4,566.98
|
| Rate for Payer: First Health Commercial |
$5,227.27
|
| Rate for Payer: Humana Commercial |
$4,677.03
|
| Rate for Payer: Humana KY Medicaid |
$1,892.27
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.65
|
| Rate for Payer: PHCS Commercial |
$5,282.29
|
| Rate for Payer: United Healthcare All Payer |
$4,842.10
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Facility
|
IP
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,063.22 |
| Max. Negotiated Rate |
$6,602.29 |
| Rate for Payer: Aetna Commercial |
$5,295.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,364.36
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$5,708.23
|
| Rate for Payer: First Health Commercial |
$6,533.52
|
| Rate for Payer: Humana Commercial |
$5,845.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,075.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,063.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,158.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,501.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,983.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.40
|
| Rate for Payer: PHCS Commercial |
$6,602.29
|
| Rate for Payer: United Healthcare All Payer |
$6,052.10
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$4,126.43 |
| Rate for Payer: Aetna Commercial |
$258.61
|
| Rate for Payer: Ambetter Exchange |
$146.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.22
|
| Rate for Payer: Anthem Medicaid |
$176.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.48
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$598.36
|
| Rate for Payer: Humana Medicaid |
$176.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.46
|
| Rate for Payer: Molina Healthcare Passport |
$176.92
|
| Rate for Payer: Multiplan PHCS |
$4,126.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.10
|
| Rate for Payer: UHCCP Medicaid |
$127.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.23
|
|
|
CYSTO W/INSERT URETERAL STENT
|
Facility
|
OP
|
$6,877.39
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
76102103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,365.13 |
| Max. Negotiated Rate |
$6,602.29 |
| Rate for Payer: Aetna Commercial |
$5,295.59
|
| Rate for Payer: Anthem Medicaid |
$2,365.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,364.36
|
| 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 |
$3,438.70
|
| Rate for Payer: Cash Price |
$3,438.70
|
| Rate for Payer: Cigna Commercial |
$5,708.23
|
| Rate for Payer: First Health Commercial |
$6,533.52
|
| Rate for Payer: Humana Commercial |
$5,845.78
|
| Rate for Payer: Humana KY Medicaid |
$2,365.13
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,389.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,075.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,412.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,158.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,501.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,983.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.40
|
| Rate for Payer: PHCS Commercial |
$6,602.29
|
| Rate for Payer: United Healthcare All Payer |
$6,052.10
|
|
|
CYSTO W/PRST8 COMMISSUROTOMY
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 0619T
|
| Hospital Charge Code |
76102962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.12 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
CYSTO W/PRST8 COMMISSUROTOMY
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 0619T
|
| Hospital Charge Code |
76102962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$997.50 |
| Max. Negotiated Rate |
$1,995.00 |
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,995.00
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
|
|
CYSTO W/PRST8 COMMISSUROTOMY
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 0619T
|
| Hospital Charge Code |
76102962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Professional
|
Both
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Aetna Commercial |
$280.98
|
| Rate for Payer: Ambetter Exchange |
$190.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.03
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.88
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$249.54
|
| Rate for Payer: Healthspan PPO |
$1,022.78
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$4,628.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.95
|
| Rate for Payer: UHCCP Medicaid |
$140.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.73
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Facility
|
IP
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,314.20 |
| Max. Negotiated Rate |
$7,405.44 |
| Rate for Payer: Aetna Commercial |
$5,939.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.92
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$6,402.62
|
| Rate for Payer: First Health Commercial |
$7,328.30
|
| Rate for Payer: Humana Commercial |
$6,556.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,711.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,322.66
|
| Rate for Payer: PHCS Commercial |
$7,405.44
|
| Rate for Payer: United Healthcare All Payer |
$6,788.32
|
|
|
CYSTO W/REMOVAL OF LESIONS SM
|
Facility
|
OP
|
$7,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
76102086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,652.84 |
| Max. Negotiated Rate |
$7,405.44 |
| Rate for Payer: Aetna Commercial |
$5,939.78
|
| Rate for Payer: Anthem Medicaid |
$2,652.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.92
|
| 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 |
$3,857.00
|
| Rate for Payer: Cash Price |
$3,857.00
|
| Rate for Payer: Cigna Commercial |
$6,402.62
|
| Rate for Payer: First Health Commercial |
$7,328.30
|
| Rate for Payer: Humana Commercial |
$6,556.90
|
| Rate for Payer: Humana KY Medicaid |
$2,652.84
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,679.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,706.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,711.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,322.66
|
| Rate for Payer: PHCS Commercial |
$7,405.44
|
| Rate for Payer: United Healthcare All Payer |
$6,788.32
|
|
|
CYSTO W/REMOVAL OF LESIONS S(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761P2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$280.98
|
| Rate for Payer: Ambetter Exchange |
$190.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.03
|
| Rate for Payer: Anthem Medicaid |
$176.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.88
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$249.54
|
| Rate for Payer: Healthspan PPO |
$1,022.78
|
| Rate for Payer: Humana Medicaid |
$176.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.51
|
| Rate for Payer: Molina Healthcare Passport |
$176.97
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.95
|
| Rate for Payer: UHCCP Medicaid |
$140.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.73
|
|
|
CYSTO W/REMOVAL OF LESIONS S(T
|
Facility
|
IP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761T2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,714.20 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,971.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,942.66
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
CYSTO W/REMOVAL OF LESIONS S(T
|
Facility
|
OP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 52224
|
| Hospital Charge Code |
761T2086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,965.04 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem Medicaid |
$1,965.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| 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 |
$2,857.00
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Humana KY Medicaid |
$1,965.04
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,985.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,004.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,971.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,942.66
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Professional
|
Both
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$4,252.84 |
| Rate for Payer: Aetna Commercial |
$410.10
|
| Rate for Payer: Ambetter Exchange |
$230.62
|
| Rate for Payer: Anthem Medicaid |
$273.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$276.74
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cigna Commercial |
$365.21
|
| Rate for Payer: Healthspan PPO |
$327.91
|
| Rate for Payer: Humana Medicaid |
$273.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$230.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.59
|
| Rate for Payer: Molina Healthcare Passport |
$273.13
|
| Rate for Payer: Multiplan PHCS |
$4,252.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$299.81
|
| Rate for Payer: UHCCP Medicaid |
$2,480.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.62
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
OP
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,437.59 |
| Max. Negotiated Rate |
$6,804.55 |
| Rate for Payer: Aetna Commercial |
$5,457.81
|
| Rate for Payer: Anthem Medicaid |
$2,437.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.69
|
| 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 |
$3,544.03
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cigna Commercial |
$5,883.10
|
| Rate for Payer: First Health Commercial |
$6,733.67
|
| Rate for Payer: Humana Commercial |
$6,024.86
|
| Rate for Payer: Humana KY Medicaid |
$2,437.59
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,231.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.77
|
| Rate for Payer: PHCS Commercial |
$6,804.55
|
| Rate for Payer: United Healthcare All Payer |
$6,237.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
OP
|
$6,138.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761T2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,110.88 |
| Max. Negotiated Rate |
$5,892.55 |
| Rate for Payer: Aetna Commercial |
$4,726.31
|
| Rate for Payer: Anthem Medicaid |
$2,110.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,787.69
|
| 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 |
$3,069.03
|
| Rate for Payer: Cash Price |
$3,069.03
|
| Rate for Payer: Cigna Commercial |
$5,094.60
|
| Rate for Payer: First Health Commercial |
$5,831.17
|
| Rate for Payer: Humana Commercial |
$5,217.36
|
| Rate for Payer: Humana KY Medicaid |
$2,110.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,132.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,033.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,153.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,401.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,603.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,910.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,340.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,235.27
|
| Rate for Payer: PHCS Commercial |
$5,892.55
|
| Rate for Payer: United Healthcare All Payer |
$5,401.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
IP
|
$6,138.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761T2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$5,892.55 |
| Rate for Payer: Aetna Commercial |
$4,726.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,787.69
|
| Rate for Payer: Cash Price |
$3,069.03
|
| Rate for Payer: Cigna Commercial |
$5,094.60
|
| Rate for Payer: First Health Commercial |
$5,831.17
|
| Rate for Payer: Humana Commercial |
$5,217.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,033.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,841.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,401.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,603.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,910.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,340.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,235.27
|
| Rate for Payer: PHCS Commercial |
$5,892.55
|
| Rate for Payer: United Healthcare All Payer |
$5,401.50
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
761P2087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$410.10
|
| Rate for Payer: Ambetter Exchange |
$230.62
|
| Rate for Payer: Anthem Medicaid |
$273.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$276.74
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$365.21
|
| Rate for Payer: Healthspan PPO |
$327.91
|
| Rate for Payer: Humana Medicaid |
$273.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$230.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.59
|
| Rate for Payer: Molina Healthcare Passport |
$273.13
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$299.81
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.62
|
|
|
CYSTO W/REMOVAL OF TUMOR SMALL
|
Facility
|
IP
|
$7,088.07
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
76102087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,126.42 |
| Max. Negotiated Rate |
$6,804.55 |
| Rate for Payer: Aetna Commercial |
$5,457.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.69
|
| Rate for Payer: Cash Price |
$3,544.03
|
| Rate for Payer: Cigna Commercial |
$5,883.10
|
| Rate for Payer: First Health Commercial |
$6,733.67
|
| Rate for Payer: Humana Commercial |
$6,024.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,231.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.77
|
| Rate for Payer: PHCS Commercial |
$6,804.55
|
| Rate for Payer: United Healthcare All Payer |
$6,237.50
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 52343
|
| Hospital Charge Code |
76102894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.19 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| 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 |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.22
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 52343
|
| Hospital Charge Code |
76102894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$588.40 |
| Rate for Payer: Aetna Commercial |
$588.40
|
| Rate for Payer: Ambetter Exchange |
$322.88
|
| Rate for Payer: Anthem Medicaid |
$291.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$387.46
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$573.41
|
| Rate for Payer: Healthspan PPO |
$470.48
|
| Rate for Payer: Humana Medicaid |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$322.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.38
|
| Rate for Payer: Molina Healthcare Passport |
$291.55
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.74
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.88
|
|
