|
BROCHE KIRSCHNER 1.5MM LG 150
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem Medicaid |
$13.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.64
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Humana KY Medicaid |
$13.07
|
| Rate for Payer: Kentucky WC Medicaid |
$13.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.78
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
BROMFED DM SYRUP 5 ML
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 121093304
|
| Hospital Charge Code |
25000347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
BROMFED DM SYRUP 5 ML
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 121093304
|
| Hospital Charge Code |
25000347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
BROMFENAC 0.09% EYEDROP 2.5 ML
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
NDC 72266014201
|
| Hospital Charge Code |
25002907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Anthem Medicaid |
$5.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.85
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cigna Commercial |
$13.68
|
| Rate for Payer: First Health Commercial |
$15.66
|
| Rate for Payer: Humana Commercial |
$14.01
|
| Rate for Payer: Humana KY Medicaid |
$5.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.50
|
| Rate for Payer: Ohio Health Group HMO |
$12.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.11
|
| Rate for Payer: PHCS Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Payer |
$14.50
|
|
|
BROMFENAC 0.09% EYEDROP 2.5 ML
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
NDC 72266014201
|
| Hospital Charge Code |
25002907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.85
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cigna Commercial |
$13.68
|
| Rate for Payer: First Health Commercial |
$15.66
|
| Rate for Payer: Humana Commercial |
$14.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.50
|
| Rate for Payer: Ohio Health Group HMO |
$12.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.11
|
| Rate for Payer: PHCS Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Payer |
$14.50
|
|
|
BRONCH EBUS IVNTJ PERPH LES
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 31654
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.88
|
| Rate for Payer: Anthem Medicaid |
$55.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$116.52
|
| Rate for Payer: Humana Medicaid |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.58
|
| Rate for Payer: Molina Healthcare Passport |
$55.47
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$57.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.02
|
|
|
BRONCH EBUS IVNTJ PERPH LES(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 31654
|
| Hospital Charge Code |
410P0058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.88
|
| Rate for Payer: Anthem Medicaid |
$55.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$116.52
|
| Rate for Payer: Humana Medicaid |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.58
|
| Rate for Payer: Molina Healthcare Passport |
$55.47
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$57.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.02
|
|
|
BRONCH EBUS IVNTJ PERPH LES(T
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS 31654
|
| Hospital Charge Code |
410T0058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$328.12 |
| Max. Negotiated Rate |
$2,423.04 |
| Rate for Payer: Aetna Commercial |
$1,943.48
|
| Rate for Payer: Anthem Medicaid |
$868.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,968.72
|
| Rate for Payer: Cash Price |
$1,262.00
|
| Rate for Payer: Cigna Commercial |
$2,094.92
|
| Rate for Payer: First Health Commercial |
$2,397.80
|
| Rate for Payer: Humana Commercial |
$2,145.40
|
| Rate for Payer: Humana KY Medicaid |
$868.00
|
| Rate for Payer: Kentucky WC Medicaid |
$876.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,069.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,862.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$885.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,221.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,893.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.44
|
| Rate for Payer: PHCS Commercial |
$2,423.04
|
| Rate for Payer: United Healthcare All Payer |
$2,221.12
|
|
|
BRONCH EBUS IVNTJ PERPH LES(T
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS 31654
|
| Hospital Charge Code |
410T0058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$328.12 |
| Max. Negotiated Rate |
$2,423.04 |
| Rate for Payer: Aetna Commercial |
$1,943.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,968.72
|
| Rate for Payer: Cash Price |
$1,262.00
|
| Rate for Payer: Cigna Commercial |
$2,094.92
|
| Rate for Payer: First Health Commercial |
$2,397.80
|
| Rate for Payer: Humana Commercial |
$2,145.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,069.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,862.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,221.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,893.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.44
|
| Rate for Payer: PHCS Commercial |
$2,423.04
|
| Rate for Payer: United Healthcare All Payer |
$2,221.12
|
|
|
BRONCH EBUS SAMPLNG 1/2 NODE
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 31652
|
| Hospital Charge Code |
41000056
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.60
|
| Rate for Payer: Anthem Medicaid |
$191.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$402.77
|
| Rate for Payer: Humana Medicaid |
$191.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.37
|
| Rate for Payer: Molina Healthcare Passport |
$191.54
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.00
|
| Rate for Payer: UHCCP Medicaid |
$199.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.46
|
|
|
BRONCH EBUS SAMPLNG 1/2 NOD(P
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 31652
|
| Hospital Charge Code |
410P0056
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.60
|
| Rate for Payer: Anthem Medicaid |
$191.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$402.77
|
| Rate for Payer: Humana Medicaid |
$191.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.37
|
| Rate for Payer: Molina Healthcare Passport |
$191.54
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.00
|
| Rate for Payer: UHCCP Medicaid |
$199.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.46
|
|
|
BRONCH EBUS SAMPLNG 3/> NODE
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 31653
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.30
|
| Rate for Payer: Anthem Medicaid |
$211.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$490.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$444.58
|
| Rate for Payer: Humana Medicaid |
$211.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$333.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.67
|
| Rate for Payer: Molina Healthcare Passport |
$211.44
|
| Rate for Payer: Multiplan PHCS |
$294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$343.00
|
| Rate for Payer: UHCCP Medicaid |
$219.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.55
|
|
|
BRONCH EBUS SAMPLNG 3/> NOD(P
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 31653
|
| Hospital Charge Code |
410P0057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.30
|
| Rate for Payer: Anthem Medicaid |
$211.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$490.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$444.58
|
| Rate for Payer: Humana Medicaid |
$211.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$333.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.67
|
| Rate for Payer: Molina Healthcare Passport |
$211.44
|
| Rate for Payer: Multiplan PHCS |
$294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$343.00
|
| Rate for Payer: UHCCP Medicaid |
$219.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.55
|
|
|
BRONCHIAL PROVOCATION - GAS
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
BRONCHIAL PROVOCATION - GAS
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$898.00 |
| Rate for Payer: Aetna Commercial |
$53.98
|
| Rate for Payer: Anthem Medicaid |
$58.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$898.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$106.45
|
| Rate for Payer: Healthspan PPO |
$72.60
|
| Rate for Payer: Humana Medicaid |
$58.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.86
|
| Rate for Payer: Molina Healthcare Passport |
$58.69
|
| Rate for Payer: Multiplan PHCS |
$538.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$628.60
|
| Rate for Payer: UHCCP Medicaid |
$314.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.28
|
|
|
BRONCHIAL PROVOCATION - GAS
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem Medicaid |
$308.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Humana KY Medicaid |
$308.82
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$311.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
BRONCHIAL PROVOCATION - GAS(P
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
460P0023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$53.98
|
| Rate for Payer: Anthem Medicaid |
$58.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$156.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$106.45
|
| Rate for Payer: Healthspan PPO |
$72.60
|
| Rate for Payer: Humana Medicaid |
$58.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.86
|
| Rate for Payer: Molina Healthcare Passport |
$58.69
|
| Rate for Payer: Multiplan PHCS |
$93.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.20
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.28
|
|
|
BRONCHIAL PROVOCATION - GAS(T
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
460T0023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
BRONCHIAL PROVOCATION - GAS(T
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
460T0023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
BRONCHIAL PROVOCATION TEST
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BRONCHIAL PROVOCATION TEST
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$94.19
|
| Rate for Payer: Anthem Medicaid |
$68.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$86.67
|
| Rate for Payer: Healthspan PPO |
$72.96
|
| Rate for Payer: Humana Medicaid |
$68.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.60
|
| Rate for Payer: Molina Healthcare Passport |
$68.24
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.92
|
|
|
BRONCHIAL PROVOCATION TEST
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BRONCHIAL PROVOCATION TEST(P
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
460P0003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna Commercial |
$94.19
|
| Rate for Payer: Anthem Medicaid |
$68.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$86.67
|
| Rate for Payer: Healthspan PPO |
$72.96
|
| Rate for Payer: Humana Medicaid |
$68.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.60
|
| Rate for Payer: Molina Healthcare Passport |
$68.24
|
| Rate for Payer: Multiplan PHCS |
$40.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.60
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.92
|
|
|
BRONCHIAL PROVOCATION TEST(T
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
460T0003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem Medicaid |
$155.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Humana KY Medicaid |
$155.44
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$157.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
|
BRONCHIAL PROVOCATION TEST(T
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
460T0003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
