|
BRONCHIAL VALVE ADDL INSERT
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
41000055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$137.65
|
| Rate for Payer: Healthspan PPO |
$77.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
BRONCHIAL VALVE ADDL INSERT(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
410P0055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$137.65
|
| Rate for Payer: Healthspan PPO |
$77.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
BRONCHIAL VALVE INIT INSERT
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
41000054
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$395.50
|
| Rate for Payer: Healthspan PPO |
$224.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.65
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
|
|
BRONCHIAL VALVE INIT INSERT(P
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
410P0054
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$395.50
|
| Rate for Payer: Healthspan PPO |
$224.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.65
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
|
|
BRONCHIAL VALVE REMOV INIT
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 31648
|
| Hospital Charge Code |
76102901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$475.00 |
| 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 |
$411.71
|
| Rate for Payer: Healthspan PPO |
$232.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$299.98
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
|
|
BRONCHIAL VALVE REMOV INIT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 31648
|
| Hospital Charge Code |
76102901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$4,533.70 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,238.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,533.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,371.79
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$3,238.36
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
BRONCHIAL VALVE REMOV INIT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 31648
|
| Hospital Charge Code |
76102901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
BRONCHIAL WASHING CELL COUNT
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
BRONCHIAL WASHING CELL COUNT
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$11,201.01
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$7,600.68 |
| Max. Negotiated Rate |
$11,201.01 |
| Rate for Payer: Anthem Medicaid |
$7,600.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,000.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,201.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,800.97
|
| Rate for Payer: Humana KY Medicaid |
$7,600.68
|
| Rate for Payer: Humana Medicare Advantage |
$8,000.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7,676.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,600.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,752.70
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$8,129.07
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,516.16 |
| Max. Negotiated Rate |
$8,129.07 |
| Rate for Payer: Anthem Medicaid |
$5,516.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,806.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,129.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,838.75
|
| Rate for Payer: Humana KY Medicaid |
$5,516.16
|
| Rate for Payer: Humana Medicare Advantage |
$5,806.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,571.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,967.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,626.48
|
|
|
BRONCHOGRAPHY
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$829.44 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Anthem Medicaid |
$297.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$717.12
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Humana Commercial |
$734.40
|
| Rate for Payer: Humana KY Medicaid |
$297.13
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$300.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$708.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$637.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$760.32
|
| Rate for Payer: Ohio Health Group HMO |
$648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.84
|
| Rate for Payer: PHCS Commercial |
$829.44
|
| Rate for Payer: United Healthcare All Payer |
$760.32
|
|
|
BRONCHOGRAPHY
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$864.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$518.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$604.80
|
| Rate for Payer: UHCCP Medicaid |
$302.40
|
|
|
BRONCHOGRAPHY
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$829.44 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$717.12
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Humana Commercial |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$708.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$637.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$760.32
|
| Rate for Payer: Ohio Health Group HMO |
$648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.84
|
| Rate for Payer: PHCS Commercial |
$829.44
|
| Rate for Payer: United Healthcare All Payer |
$760.32
|
|
|
BRONCHOGRAPHY(T
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
320T0188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$829.44 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Anthem Medicaid |
$297.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$717.12
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Humana Commercial |
$734.40
|
| Rate for Payer: Humana KY Medicaid |
$297.13
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$300.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$708.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$637.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$760.32
|
| Rate for Payer: Ohio Health Group HMO |
$648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.84
|
| Rate for Payer: PHCS Commercial |
$829.44
|
| Rate for Payer: United Healthcare All Payer |
$760.32
|
|
|
BRONCHOGRAPHY(T
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
320T0188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$829.44 |
| Rate for Payer: Aetna Commercial |
$665.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$717.12
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Humana Commercial |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$708.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$637.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$760.32
|
| Rate for Payer: Ohio Health Group HMO |
$648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.84
|
| Rate for Payer: PHCS Commercial |
$829.44
|
| Rate for Payer: United Healthcare All Payer |
$760.32
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
761P1194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$428.49
|
| Rate for Payer: Anthem Medicaid |
$270.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$400.11
|
| Rate for Payer: Healthspan PPO |
$334.56
|
| Rate for Payer: Humana Medicaid |
$270.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$345.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.63
|
| Rate for Payer: Molina Healthcare Passport |
$270.23
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.93
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
76101194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
76101194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
76101194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$428.49
|
| Rate for Payer: Anthem Medicaid |
$270.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$400.11
|
| Rate for Payer: Healthspan PPO |
$334.56
|
| Rate for Payer: Humana Medicaid |
$270.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$345.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.63
|
| Rate for Payer: Molina Healthcare Passport |
$270.23
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.93
|
|
|
BRONCHOSCOPY BRONCH STENTS
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 31636
|
| Hospital Charge Code |
41000046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$158.55 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$378.11
|
| Rate for Payer: Anthem Medicaid |
$180.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.00
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$346.97
|
| Rate for Payer: Healthspan PPO |
$295.22
|
| Rate for Payer: Humana Medicaid |
$180.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$292.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.13
|
| Rate for Payer: Molina Healthcare Passport |
$180.52
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.10
|
| Rate for Payer: UHCCP Medicaid |
$158.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.33
|
|
|
BRONCHOSCOPY BRONCH STENTS(P
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 31636
|
| Hospital Charge Code |
410P0046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$158.55 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$378.11
|
| Rate for Payer: Anthem Medicaid |
$180.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.00
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$346.97
|
| Rate for Payer: Healthspan PPO |
$295.22
|
| Rate for Payer: Humana Medicaid |
$180.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$292.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.13
|
| Rate for Payer: Molina Healthcare Passport |
$180.52
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.10
|
| Rate for Payer: UHCCP Medicaid |
$158.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.33
|
|
|
BRONCHOSCOPY DILATE/FX REPR
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 31630
|
| Hospital Charge Code |
41000042
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.25 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna Commercial |
$344.27
|
| Rate for Payer: Anthem Medicaid |
$224.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$415.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$317.49
|
| Rate for Payer: Healthspan PPO |
$268.80
|
| Rate for Payer: Humana Medicaid |
$224.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.50
|
| Rate for Payer: Molina Healthcare Passport |
$224.02
|
| Rate for Payer: Multiplan PHCS |
$249.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.50
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.26
|
|
|
BRONCHOSCOPY DILATE/FX REPR(P
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 31630
|
| Hospital Charge Code |
410P0042
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.25 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna Commercial |
$344.27
|
| Rate for Payer: Anthem Medicaid |
$224.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$415.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$317.49
|
| Rate for Payer: Healthspan PPO |
$268.80
|
| Rate for Payer: Humana Medicaid |
$224.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.50
|
| Rate for Payer: Molina Healthcare Passport |
$224.02
|
| Rate for Payer: Multiplan PHCS |
$249.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.50
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.26
|
|
|
BRONCHOSCOPY/LUNG BX EACH
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$503.64 |
| Rate for Payer: Aetna Commercial |
$318.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.77
|
| Rate for Payer: Anthem Medicaid |
$251.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$288.94
|
| Rate for Payer: Healthspan PPO |
$503.64
|
| Rate for Payer: Humana Medicaid |
$251.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$243.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.96
|
| Rate for Payer: Molina Healthcare Passport |
$251.92
|
| Rate for Payer: Multiplan PHCS |
$268.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$313.60
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.44
|
|
