|
TRAB MTL TIBCNE 67-30M FULL LG
|
Facility
|
OP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem Medicaid |
$7,921.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Humana KY Medicaid |
$7,921.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,002.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,080.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIBCNE 67-30M FULL LG
|
Facility
|
IP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 48-15M FULXS
|
Facility
|
IP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 48-15M FULXS
|
Facility
|
OP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem Medicaid |
$7,921.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Humana KY Medicaid |
$7,921.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,002.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,080.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 52-15M FULSM
|
Facility
|
IP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 52-15M FULSM
|
Facility
|
OP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem Medicaid |
$7,921.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Humana KY Medicaid |
$7,921.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,002.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,080.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 59-15M FULLM
|
Facility
|
IP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 59-15M FULLM
|
Facility
|
OP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem Medicaid |
$7,921.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Humana KY Medicaid |
$7,921.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,002.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,080.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 59-30M FULLM
|
Facility
|
IP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRAB MTL TIB CONE 59-30M FULLM
|
Facility
|
OP
|
$23,035.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.63 |
| Max. Negotiated Rate |
$22,114.16 |
| Rate for Payer: Aetna Commercial |
$17,737.40
|
| Rate for Payer: Anthem Medicaid |
$7,921.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,967.75
|
| Rate for Payer: Cash Price |
$11,517.79
|
| Rate for Payer: Cigna Commercial |
$19,119.53
|
| Rate for Payer: First Health Commercial |
$21,883.80
|
| Rate for Payer: Humana Commercial |
$19,580.24
|
| Rate for Payer: Humana KY Medicaid |
$7,921.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,002.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,889.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,000.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,910.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,080.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,271.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,276.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,607.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,141.03
|
| Rate for Payer: PHCS Commercial |
$22,114.16
|
| Rate for Payer: United Healthcare All Payer |
$20,271.31
|
|
|
TRACE MINERALS STANDARD DO 1ML
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 517720125
|
| Hospital Charge Code |
25003529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Aetna Commercial |
$91.82
|
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.02
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.98
|
| Rate for Payer: First Health Commercial |
$113.29
|
| Rate for Payer: Humana Commercial |
$101.36
|
| Rate for Payer: Humana KY Medicaid |
$41.01
|
| Rate for Payer: Kentucky WC Medicaid |
$41.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.94
|
| Rate for Payer: Ohio Health Group HMO |
$89.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.97
|
| Rate for Payer: PHCS Commercial |
$114.48
|
| Rate for Payer: United Healthcare All Payer |
$104.94
|
|
|
TRACE MINERALS STANDARD DO 1ML
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 517720125
|
| Hospital Charge Code |
25003529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Aetna Commercial |
$91.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.02
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.98
|
| Rate for Payer: First Health Commercial |
$113.29
|
| Rate for Payer: Humana Commercial |
$101.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.94
|
| Rate for Payer: Ohio Health Group HMO |
$89.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.97
|
| Rate for Payer: PHCS Commercial |
$114.48
|
| Rate for Payer: United Healthcare All Payer |
$104.94
|
|
|
TRACH BLUE RHINO SHI 8.5
|
Facility
|
IP
|
$4,062.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.06 |
| Max. Negotiated Rate |
$3,899.52 |
| Rate for Payer: Aetna Commercial |
$3,127.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.36
|
| Rate for Payer: Cash Price |
$2,031.00
|
| Rate for Payer: Cigna Commercial |
$3,371.46
|
| Rate for Payer: First Health Commercial |
$3,858.90
|
| Rate for Payer: Humana Commercial |
$3,452.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,330.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,997.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,574.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.22
|
| Rate for Payer: PHCS Commercial |
$3,899.52
|
| Rate for Payer: United Healthcare All Payer |
$3,574.56
|
|
|
TRACH BLUE RHINO SHI 8.5
|
Facility
|
OP
|
$4,062.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.06 |
| Max. Negotiated Rate |
$3,899.52 |
| Rate for Payer: Aetna Commercial |
$3,127.74
|
| Rate for Payer: Anthem Medicaid |
$1,396.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.36
|
| Rate for Payer: Cash Price |
$2,031.00
|
| Rate for Payer: Cigna Commercial |
$3,371.46
|
| Rate for Payer: First Health Commercial |
$3,858.90
|
| Rate for Payer: Humana Commercial |
$3,452.70
|
| Rate for Payer: Humana KY Medicaid |
$1,396.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,330.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,997.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,424.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,574.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.22
|
| Rate for Payer: PHCS Commercial |
$3,899.52
|
| Rate for Payer: United Healthcare All Payer |
$3,574.56
|
|
|
TRACHEAL NEEDLE ASPIRATE
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 31612
|
| Hospital Charge Code |
41000032
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$79.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.40
|
| Rate for Payer: Anthem Medicaid |
$61.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: Healthspan PPO |
$97.40
|
| Rate for Payer: Humana Medicaid |
$61.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.22
|
| Rate for Payer: Molina Healthcare Passport |
$61.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$25.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.61
|
|
|
TRACHEAL NEEDLE ASPIRATE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 31612
|
| Hospital Charge Code |
410P0032
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$79.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.40
|
| Rate for Payer: Anthem Medicaid |
$61.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: Healthspan PPO |
$97.40
|
| Rate for Payer: Humana Medicaid |
$61.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.22
|
| Rate for Payer: Molina Healthcare Passport |
$61.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$25.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.61
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
45000218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
OP
|
$2,415.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
76101168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Aetna Commercial |
$1,859.55
|
| Rate for Payer: Anthem Medicaid |
$830.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,883.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$1,207.50
|
| Rate for Payer: Cash Price |
$1,207.50
|
| Rate for Payer: Cigna Commercial |
$2,004.45
|
| Rate for Payer: First Health Commercial |
$2,294.25
|
| Rate for Payer: Humana Commercial |
$2,052.75
|
| Rate for Payer: Humana KY Medicaid |
$830.52
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$838.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,980.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,782.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$847.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,125.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$483.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$748.65
|
| Rate for Payer: PHCS Commercial |
$2,318.40
|
| Rate for Payer: United Healthcare All Payer |
$2,125.20
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
45000218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Professional
|
Both
|
$2,415.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
76101168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$2,415.00 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.36
|
| Rate for Payer: Anthem Medicaid |
$118.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,415.00
|
| Rate for Payer: Cash Price |
$1,207.50
|
| Rate for Payer: Cash Price |
$1,207.50
|
| Rate for Payer: Cigna Commercial |
$187.70
|
| Rate for Payer: Healthspan PPO |
$221.04
|
| Rate for Payer: Humana Medicaid |
$118.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Healthcare Passport |
$118.98
|
| Rate for Payer: Multiplan PHCS |
$1,449.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,690.50
|
| Rate for Payer: UHCCP Medicaid |
$78.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.17
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
IP
|
$2,415.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
76101168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Aetna Commercial |
$1,859.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,883.70
|
| Rate for Payer: Cash Price |
$1,207.50
|
| Rate for Payer: Cigna Commercial |
$2,004.45
|
| Rate for Payer: First Health Commercial |
$2,294.25
|
| Rate for Payer: Humana Commercial |
$2,052.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,980.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,782.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$724.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,125.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$483.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$748.65
|
| Rate for Payer: PHCS Commercial |
$2,318.40
|
| Rate for Payer: United Healthcare All Payer |
$2,125.20
|
|
|
TRACHEOBRONCH THRGH TRACHINC(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
761P1168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.36
|
| Rate for Payer: Anthem Medicaid |
$118.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$187.70
|
| Rate for Payer: Healthspan PPO |
$221.04
|
| Rate for Payer: Humana Medicaid |
$118.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.36
|
| Rate for Payer: Molina Healthcare Passport |
$118.98
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$78.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.17
|
|
|
TRACHEOBRONCH THRGH TRACHINC(T
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
761T1168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.20 |
| Max. Negotiated Rate |
$1,862.40 |
| Rate for Payer: Aetna Commercial |
$1,493.80
|
| Rate for Payer: Anthem Medicaid |
$667.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$970.00
|
| Rate for Payer: Cash Price |
$970.00
|
| Rate for Payer: Cigna Commercial |
$1,610.20
|
| Rate for Payer: First Health Commercial |
$1,843.00
|
| Rate for Payer: Humana Commercial |
$1,649.00
|
| Rate for Payer: Humana KY Medicaid |
$667.17
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$673.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.40
|
| Rate for Payer: PHCS Commercial |
$1,862.40
|
| Rate for Payer: United Healthcare All Payer |
$1,707.20
|
|
|
TRACHEOBRONCH THRGH TRACHINC(T
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
761T1168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.20 |
| Max. Negotiated Rate |
$1,862.40 |
| Rate for Payer: Aetna Commercial |
$1,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.20
|
| Rate for Payer: Cash Price |
$970.00
|
| Rate for Payer: Cigna Commercial |
$1,610.20
|
| Rate for Payer: First Health Commercial |
$1,843.00
|
| Rate for Payer: Humana Commercial |
$1,649.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.40
|
| Rate for Payer: PHCS Commercial |
$1,862.40
|
| Rate for Payer: United Healthcare All Payer |
$1,707.20
|
|
|
TRACHEOBRONC W/FIBERSCOPE
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 31725
|
| Hospital Charge Code |
41000061
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$159.57
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$145.88
|
| Rate for Payer: Healthspan PPO |
$124.59
|
| Rate for Payer: Humana Medicaid |
$98.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
|
