|
TRAB MTL TIB CONE 59-30M FULLM
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRACE MINERALS STANDARD DO 1ML
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 517720125
|
| Hospital Charge Code |
25003529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.77 |
| 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 |
$35.77
|
| 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 |
$95.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.28
|
| 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 |
$35.77 |
| 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 |
$35.77
|
| 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 |
$95.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.28
|
| Rate for Payer: PHCS Commercial |
$114.48
|
| Rate for Payer: United Healthcare All Payer |
$104.94
|
|
|
TRACH BLUE RHINO SHI 8.5
|
Facility
|
OP
|
$4,322.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.71 |
| Max. Negotiated Rate |
$4,149.48 |
| Rate for Payer: Aetna Commercial |
$3,328.23
|
| Rate for Payer: Anthem Medicaid |
$1,486.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.46
|
| Rate for Payer: Cash Price |
$2,161.19
|
| Rate for Payer: Cigna Commercial |
$3,587.58
|
| Rate for Payer: First Health Commercial |
$4,106.26
|
| Rate for Payer: Humana Commercial |
$3,674.02
|
| Rate for Payer: Humana KY Medicaid |
$1,486.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,501.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,189.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,516.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,803.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,241.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,457.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,760.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.44
|
| Rate for Payer: PHCS Commercial |
$4,149.48
|
| Rate for Payer: United Healthcare All Payer |
$3,803.69
|
|
|
TRACH BLUE RHINO SHI 8.5
|
Facility
|
IP
|
$4,322.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.71 |
| Max. Negotiated Rate |
$4,149.48 |
| Rate for Payer: Aetna Commercial |
$3,328.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.46
|
| Rate for Payer: Cash Price |
$2,161.19
|
| Rate for Payer: Cigna Commercial |
$3,587.58
|
| Rate for Payer: First Health Commercial |
$4,106.26
|
| Rate for Payer: Humana Commercial |
$3,674.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,189.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,803.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,241.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,457.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,760.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.44
|
| Rate for Payer: PHCS Commercial |
$4,149.48
|
| Rate for Payer: United Healthcare All Payer |
$3,803.69
|
|
|
TRACHEAL NEEDLE ASPIRATE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 31612
|
| Hospital Charge Code |
41000032
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
TRACHEAL NEEDLE ASPIRATE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 31612
|
| Hospital Charge Code |
41000032
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
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 |
$180.00 |
| Rate for Payer: Aetna Commercial |
$79.66
|
| Rate for Payer: Ambetter Exchange |
$45.94
|
| 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 Individual/Medicaid |
$45.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.94
|
| 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 |
$59.72
|
| Rate for Payer: UHCCP Medicaid |
$25.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.94
|
|
|
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 |
$180.00 |
| Rate for Payer: Aetna Commercial |
$79.66
|
| Rate for Payer: Ambetter Exchange |
$45.94
|
| 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 Individual/Medicaid |
$45.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.94
|
| 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 |
$59.72
|
| Rate for Payer: UHCCP Medicaid |
$25.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.94
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
45000218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.00 |
| 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 |
$1,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.60
|
| Rate for Payer: PHCS Commercial |
$1,862.40
|
| Rate for Payer: United Healthcare All Payer |
$1,707.20
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
45000218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$470.54 |
| 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 |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$1,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.60
|
| Rate for Payer: PHCS Commercial |
$1,862.40
|
| Rate for Payer: United Healthcare All Payer |
$1,707.20
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
IP
|
$2,415.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
76101168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$724.50 |
| 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 |
$1,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,666.35
|
| Rate for Payer: PHCS Commercial |
$2,318.40
|
| Rate for Payer: United Healthcare All Payer |
$2,125.20
|
|
|
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 |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Ambetter Exchange |
$108.83
|
| 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 Individual/Medicaid |
$108.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$130.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$108.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.83
|
| 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 |
$141.48
|
| Rate for Payer: UHCCP Medicaid |
$78.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.83
|
|
|
TRACHEOBRONCH THRGH TRACHINC
|
Facility
|
OP
|
$2,415.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
76101168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| 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 |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,883.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$1,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,666.35
|
| 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 |
$285.00 |
| Rate for Payer: Aetna Commercial |
$206.80
|
| Rate for Payer: Ambetter Exchange |
$108.83
|
| 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 Individual/Medicaid |
$108.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$130.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$108.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.83
|
| 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 |
$141.48
|
| Rate for Payer: UHCCP Medicaid |
$78.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.83
|
|
|
TRACHEOBRONCH THRGH TRACHINC(T
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
761T1168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| 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 |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$1,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.60
|
| 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 |
$582.00 |
| 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 |
$1,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.60
|
| Rate for Payer: PHCS Commercial |
$1,862.40
|
| Rate for Payer: United Healthcare All Payer |
$1,707.20
|
|
|
TRACHEOBRONC W/FIBERSCOPE
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 31725
|
| Hospital Charge Code |
41000061
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
TRACHEOBRONC W/FIBERSCOPE
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 31725
|
| Hospital Charge Code |
41000061
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
TRACHEOBRONC W/FIBERSCOPE
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 31725
|
| Hospital Charge Code |
41000061
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$159.57
|
| Rate for Payer: Ambetter Exchange |
$74.17
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$74.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.17
|
| 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 |
$96.42
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.17
|
|
|
TRACHEOBRONC W/FIBERSCOPE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 31725
|
| Hospital Charge Code |
410P0061
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$159.57
|
| Rate for Payer: Ambetter Exchange |
$74.17
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$74.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.17
|
| 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 |
$96.42
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.17
|
|
|
TRACHEOSTOMY
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
41000029
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$372.33
|
| Rate for Payer: Ambetter Exchange |
$301.65
|
| Rate for Payer: Anthem Medicaid |
$251.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$361.98
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$339.79
|
| Rate for Payer: Healthspan PPO |
$290.71
|
| Rate for Payer: Humana Medicaid |
$251.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$293.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.30
|
| Rate for Payer: Molina Healthcare Passport |
$251.27
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.14
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.65
|
|
|
TRACHEOSTOMY
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
41000029
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
TRACHEOSTOMY
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
41000029
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
TRACHEOSTOMY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
410P0029
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$372.33
|
| Rate for Payer: Ambetter Exchange |
$301.65
|
| Rate for Payer: Anthem Medicaid |
$251.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$361.98
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$339.79
|
| Rate for Payer: Healthspan PPO |
$290.71
|
| Rate for Payer: Humana Medicaid |
$251.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$293.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.30
|
| Rate for Payer: Molina Healthcare Passport |
$251.27
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.14
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.65
|
|
