|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.07 |
| Max. Negotiated Rate |
$3,913.80 |
| Rate for Payer: Aetna Commercial |
$613.47
|
| Rate for Payer: Ambetter Exchange |
$332.37
|
| Rate for Payer: Anthem Medicaid |
$305.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.84
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$545.40
|
| Rate for Payer: Healthspan PPO |
$490.52
|
| Rate for Payer: Humana Medicaid |
$305.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$505.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.17
|
| Rate for Payer: Molina Healthcare Passport |
$305.07
|
| Rate for Payer: Multiplan PHCS |
$3,913.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$432.08
|
| Rate for Payer: UHCCP Medicaid |
$2,283.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.37
|
|
|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Facility
|
IP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,956.90 |
| Max. Negotiated Rate |
$6,262.08 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,956.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,675.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,500.87
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN STN
|
Facility
|
OP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
76102107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,243.26 |
| Max. Negotiated Rate |
$6,262.08 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem Medicaid |
$2,243.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| 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 |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Humana KY Medicaid |
$2,243.26
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,675.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,500.87
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761P2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.07 |
| Max. Negotiated Rate |
$613.47 |
| Rate for Payer: Aetna Commercial |
$613.47
|
| Rate for Payer: Ambetter Exchange |
$332.37
|
| Rate for Payer: Anthem Medicaid |
$305.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.84
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$545.40
|
| Rate for Payer: Healthspan PPO |
$490.52
|
| Rate for Payer: Humana Medicaid |
$305.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$505.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.17
|
| Rate for Payer: Molina Healthcare Passport |
$305.07
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$432.08
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.37
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(T
|
Facility
|
OP
|
$5,623.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761T2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,933.75 |
| Max. Negotiated Rate |
$5,398.08 |
| Rate for Payer: Aetna Commercial |
$4,329.71
|
| Rate for Payer: Anthem Medicaid |
$1,933.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.94
|
| 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 |
$2,811.50
|
| Rate for Payer: Cash Price |
$2,811.50
|
| Rate for Payer: Cigna Commercial |
$4,667.09
|
| Rate for Payer: First Health Commercial |
$5,341.85
|
| Rate for Payer: Humana Commercial |
$4,779.55
|
| Rate for Payer: Humana KY Medicaid |
$1,933.75
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,953.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,972.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,948.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,217.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,892.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,879.87
|
| Rate for Payer: PHCS Commercial |
$5,398.08
|
| Rate for Payer: United Healthcare All Payer |
$4,948.24
|
|
|
CYSTO WURTRSCPY WRMVL/MAN ST(T
|
Facility
|
IP
|
$5,623.00
|
|
|
Service Code
|
HCPCS 52352
|
| Hospital Charge Code |
761T2107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.90 |
| Max. Negotiated Rate |
$5,398.08 |
| Rate for Payer: Aetna Commercial |
$4,329.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.94
|
| Rate for Payer: Cash Price |
$2,811.50
|
| Rate for Payer: Cigna Commercial |
$4,667.09
|
| Rate for Payer: First Health Commercial |
$5,341.85
|
| Rate for Payer: Humana Commercial |
$4,779.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,948.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,217.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,892.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,879.87
|
| Rate for Payer: PHCS Commercial |
$5,398.08
|
| Rate for Payer: United Healthcare All Payer |
$4,948.24
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$2,528.40 |
| Rate for Payer: Aetna Commercial |
$261.93
|
| Rate for Payer: Ambetter Exchange |
$152.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.33
|
| Rate for Payer: Anthem Medicaid |
$125.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.20
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$826.17
|
| Rate for Payer: Healthspan PPO |
$528.69
|
| Rate for Payer: Humana Medicaid |
$125.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.40
|
| Rate for Payer: Molina Healthcare Passport |
$125.88
|
| Rate for Payer: Multiplan PHCS |
$2,528.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.47
|
| Rate for Payer: UHCCP Medicaid |
$110.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.67
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,449.19 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem Medicaid |
$1,449.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| 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 |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Humana KY Medicaid |
$1,449.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,666.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,907.66
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
CYSTRTHRSCPY DIL BLD W/ANESTH
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
76102091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.20 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,666.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,907.66
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761P2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.33 |
| Max. Negotiated Rate |
$826.17 |
| Rate for Payer: Aetna Commercial |
$261.93
|
| Rate for Payer: Ambetter Exchange |
$152.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.33
|
| Rate for Payer: Anthem Medicaid |
$125.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.20
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$826.17
|
| Rate for Payer: Healthspan PPO |
$528.69
|
| Rate for Payer: Humana Medicaid |
$125.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.40
|
| Rate for Payer: Molina Healthcare Passport |
$125.88
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.47
|
| Rate for Payer: UHCCP Medicaid |
$110.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.67
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(T
|
Facility
|
IP
|
$3,849.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761T2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,154.70 |
| Max. Negotiated Rate |
$3,695.04 |
| Rate for Payer: Aetna Commercial |
$2,963.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,002.22
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$3,194.67
|
| Rate for Payer: First Health Commercial |
$3,656.55
|
| Rate for Payer: Humana Commercial |
$3,271.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,156.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,840.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,387.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,886.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,348.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.81
|
| Rate for Payer: PHCS Commercial |
$3,695.04
|
| Rate for Payer: United Healthcare All Payer |
$3,387.12
|
|
|
CYSTRTHRSCPY DIL BLD W/ANEST(T
|
Facility
|
OP
|
$3,849.00
|
|
|
Service Code
|
HCPCS 52265
|
| Hospital Charge Code |
761T2091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,323.67 |
| Max. Negotiated Rate |
$3,695.04 |
| Rate for Payer: Aetna Commercial |
$2,963.73
|
| Rate for Payer: Anthem Medicaid |
$1,323.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,002.22
|
| 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 |
$1,924.50
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$3,194.67
|
| Rate for Payer: First Health Commercial |
$3,656.55
|
| Rate for Payer: Humana Commercial |
$3,271.65
|
| Rate for Payer: Humana KY Medicaid |
$1,323.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,337.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,156.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,840.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,350.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,387.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,886.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,348.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.81
|
| Rate for Payer: PHCS Commercial |
$3,695.04
|
| Rate for Payer: United Healthcare All Payer |
$3,387.12
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
IP
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,170.13 |
| Max. Negotiated Rate |
$10,144.42 |
| Rate for Payer: Aetna Commercial |
$8,136.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,242.34
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$8,770.69
|
| Rate for Payer: First Health Commercial |
$10,038.75
|
| Rate for Payer: Humana Commercial |
$8,982.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,798.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,170.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,299.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,925.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,453.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,193.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,291.30
|
| Rate for Payer: PHCS Commercial |
$10,144.42
|
| Rate for Payer: United Healthcare All Payer |
$9,299.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
IP
|
$8,092.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761T2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,427.63 |
| Max. Negotiated Rate |
$7,768.42 |
| Rate for Payer: Aetna Commercial |
$6,230.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.84
|
| Rate for Payer: Cash Price |
$4,046.05
|
| Rate for Payer: Cigna Commercial |
$6,716.44
|
| Rate for Payer: First Health Commercial |
$7,687.49
|
| Rate for Payer: Humana Commercial |
$6,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,040.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.55
|
| Rate for Payer: PHCS Commercial |
$7,768.42
|
| Rate for Payer: United Healthcare All Payer |
$7,121.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
OP
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,634.03 |
| Max. Negotiated Rate |
$10,144.42 |
| Rate for Payer: Aetna Commercial |
$8,136.67
|
| Rate for Payer: Anthem Medicaid |
$3,634.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,242.34
|
| 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 |
$5,283.55
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$8,770.69
|
| Rate for Payer: First Health Commercial |
$10,038.75
|
| Rate for Payer: Humana Commercial |
$8,982.03
|
| Rate for Payer: Humana KY Medicaid |
$3,634.03
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,671.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,798.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,299.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,925.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,453.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,193.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,291.30
|
| Rate for Payer: PHCS Commercial |
$10,144.42
|
| Rate for Payer: United Healthcare All Payer |
$9,299.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Professional
|
Both
|
$10,567.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
76102089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.93 |
| Max. Negotiated Rate |
$6,340.26 |
| Rate for Payer: Aetna Commercial |
$841.98
|
| Rate for Payer: Ambetter Exchange |
$366.93
|
| Rate for Payer: Anthem Medicaid |
$596.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$366.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$366.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.32
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cash Price |
$5,283.55
|
| Rate for Payer: Cigna Commercial |
$753.02
|
| Rate for Payer: Healthspan PPO |
$673.24
|
| Rate for Payer: Humana Medicaid |
$596.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$366.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.06
|
| Rate for Payer: Molina Healthcare Passport |
$596.14
|
| Rate for Payer: Multiplan PHCS |
$6,340.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.01
|
| Rate for Payer: UHCCP Medicaid |
$3,698.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$366.93
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Facility
|
OP
|
$8,092.10
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761T2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,782.87 |
| Max. Negotiated Rate |
$7,768.42 |
| Rate for Payer: Aetna Commercial |
$6,230.92
|
| Rate for Payer: Anthem Medicaid |
$2,782.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.84
|
| 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 |
$4,046.05
|
| Rate for Payer: Cash Price |
$4,046.05
|
| Rate for Payer: Cigna Commercial |
$6,716.44
|
| Rate for Payer: First Health Commercial |
$7,687.49
|
| Rate for Payer: Humana Commercial |
$6,878.28
|
| Rate for Payer: Humana KY Medicaid |
$2,782.87
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,040.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.55
|
| Rate for Payer: PHCS Commercial |
$7,768.42
|
| Rate for Payer: United Healthcare All Payer |
$7,121.05
|
|
|
CYSTRTHRSCPY WDEST/RMVL TUM LG
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 52240
|
| Hospital Charge Code |
761P2089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.93 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna Commercial |
$841.98
|
| Rate for Payer: Ambetter Exchange |
$366.93
|
| Rate for Payer: Anthem Medicaid |
$596.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$366.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$366.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.32
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$753.02
|
| Rate for Payer: Healthspan PPO |
$673.24
|
| Rate for Payer: Humana Medicaid |
$596.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$692.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$366.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.06
|
| Rate for Payer: Molina Healthcare Passport |
$596.14
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.01
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$366.93
|
|
|
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 |
$270.17 |
| Max. Negotiated Rate |
$5,082.00 |
| Rate for Payer: Aetna Commercial |
$480.98
|
| Rate for Payer: Ambetter Exchange |
$270.17
|
| Rate for Payer: Anthem Medicaid |
$366.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$270.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$324.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$270.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.17
|
| 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 |
$351.22
|
| Rate for Payer: UHCCP Medicaid |
$2,964.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$270.17
|
|
|
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 |
$270.17 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$480.98
|
| Rate for Payer: Ambetter Exchange |
$270.17
|
| Rate for Payer: Anthem Medicaid |
$366.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$270.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$324.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$270.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.17
|
| 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 |
$351.22
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$270.17
|
|
|
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 |
$2,328.20 |
| 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 |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,280.60
|
| 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 |
$3,385.00
|
| 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 |
$3,186.78
|
| 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 |
$3,824.14
|
| 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 |
$5,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,889.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,671.30
|
| Rate for Payer: PHCS Commercial |
$6,499.20
|
| Rate for Payer: United Healthcare All Payer |
$5,957.60
|
|
|
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 |
$2,541.00 |
| 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 |
$6,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,368.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,844.30
|
| Rate for Payer: PHCS Commercial |
$8,131.20
|
| Rate for Payer: United Healthcare All Payer |
$7,453.60
|
|
|
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 |
$2,912.83 |
| 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 |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,606.60
|
| 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 |
$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 |
$3,186.78
|
| 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 |
$3,824.14
|
| 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 |
$6,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,368.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,844.30
|
| 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 |
$2,031.00 |
| 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 |
$5,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,889.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,671.30
|
| Rate for Payer: PHCS Commercial |
$6,499.20
|
| Rate for Payer: United Healthcare All Payer |
$5,957.60
|
|
|
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 |
$1,424.75 |
| 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 |
$3,799.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.93
|
| Rate for Payer: PHCS Commercial |
$4,559.20
|
| Rate for Payer: United Healthcare All Payer |
$4,179.27
|
|
