|
BRONCHOSCOPY W FOREIGN BODY
|
Facility
|
IP
|
$4,401.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
76101171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.13 |
| Max. Negotiated Rate |
$4,224.96 |
| Rate for Payer: Aetna Commercial |
$3,388.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.78
|
| Rate for Payer: Cash Price |
$2,200.50
|
| Rate for Payer: Cigna Commercial |
$3,652.83
|
| Rate for Payer: First Health Commercial |
$4,180.95
|
| Rate for Payer: Humana Commercial |
$3,740.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,320.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.31
|
| Rate for Payer: PHCS Commercial |
$4,224.96
|
| Rate for Payer: United Healthcare All Payer |
$3,872.88
|
|
|
BRONCHOSCOPY W FOREIGN BODY
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
45000221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
BRONCHOSCOPY W FOREIGN BODY
|
Facility
|
OP
|
$4,401.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
76101171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.13 |
| Max. Negotiated Rate |
$4,224.96 |
| Rate for Payer: Aetna Commercial |
$3,388.77
|
| Rate for Payer: Anthem Medicaid |
$1,513.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,200.50
|
| Rate for Payer: Cash Price |
$2,200.50
|
| Rate for Payer: Cigna Commercial |
$3,652.83
|
| Rate for Payer: First Health Commercial |
$4,180.95
|
| Rate for Payer: Humana Commercial |
$3,740.85
|
| Rate for Payer: Humana KY Medicaid |
$1,513.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,543.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.31
|
| Rate for Payer: PHCS Commercial |
$4,224.96
|
| Rate for Payer: United Healthcare All Payer |
$3,872.88
|
|
|
BRONCHOSCOPY W FOREIGN BODY
|
Professional
|
Both
|
$4,401.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
76101171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.59 |
| Max. Negotiated Rate |
$4,401.00 |
| Rate for Payer: Aetna Commercial |
$318.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.59
|
| Rate for Payer: Anthem Medicaid |
$242.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,401.00
|
| Rate for Payer: Cash Price |
$2,200.50
|
| Rate for Payer: Cash Price |
$2,200.50
|
| Rate for Payer: Cigna Commercial |
$290.83
|
| Rate for Payer: Healthspan PPO |
$434.56
|
| Rate for Payer: Humana Medicaid |
$242.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.22
|
| Rate for Payer: Molina Healthcare Passport |
$242.37
|
| Rate for Payer: Multiplan PHCS |
$2,640.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,080.70
|
| Rate for Payer: UHCCP Medicaid |
$93.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.79
|
|
|
BRONCHOSCOPY W FOREIGN BODY
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
45000221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,054.81 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
BRONCHOSCOPY W FOREIGN BODY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
761P1171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.59 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$318.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.59
|
| Rate for Payer: Anthem Medicaid |
$242.37
|
| 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 |
$290.83
|
| Rate for Payer: Healthspan PPO |
$434.56
|
| Rate for Payer: Humana Medicaid |
$242.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.22
|
| Rate for Payer: Molina Healthcare Passport |
$242.37
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$93.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.79
|
|
|
BRONCHOSCOPY W FOREIGN BODY(T
|
Facility
|
IP
|
$3,401.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
761T1171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.13 |
| Max. Negotiated Rate |
$3,264.96 |
| Rate for Payer: Aetna Commercial |
$2,618.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.78
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cigna Commercial |
$2,822.83
|
| Rate for Payer: First Health Commercial |
$3,230.95
|
| Rate for Payer: Humana Commercial |
$2,890.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.31
|
| Rate for Payer: PHCS Commercial |
$3,264.96
|
| Rate for Payer: United Healthcare All Payer |
$2,992.88
|
|
|
BRONCHOSCOPY W FOREIGN BODY(T
|
Facility
|
OP
|
$3,401.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
761T1171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.13 |
| Max. Negotiated Rate |
$3,264.96 |
| Rate for Payer: Aetna Commercial |
$2,618.77
|
| Rate for Payer: Anthem Medicaid |
$1,169.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cigna Commercial |
$2,822.83
|
| Rate for Payer: First Health Commercial |
$3,230.95
|
| Rate for Payer: Humana Commercial |
$2,890.85
|
| Rate for Payer: Humana KY Medicaid |
$1,169.60
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,193.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.31
|
| Rate for Payer: PHCS Commercial |
$3,264.96
|
| Rate for Payer: United Healthcare All Payer |
$2,992.88
|
|
|
BRONCHOSCOPY W/MARKERS
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 31626
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$99.32 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial |
$359.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.32
|
| Rate for Payer: Anthem Medicaid |
$161.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.00
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$347.42
|
| Rate for Payer: Healthspan PPO |
$429.60
|
| Rate for Payer: Humana Medicaid |
$161.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.33
|
| Rate for Payer: Molina Healthcare Passport |
$161.11
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$521.50
|
| Rate for Payer: UHCCP Medicaid |
$104.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.72
|
|
|
BRONCHOSCOPY W/MARKERS(P
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 31626
|
| Hospital Charge Code |
410P0038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$99.32 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial |
$359.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.32
|
| Rate for Payer: Anthem Medicaid |
$161.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.00
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$347.42
|
| Rate for Payer: Healthspan PPO |
$429.60
|
| Rate for Payer: Humana Medicaid |
$161.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.33
|
| Rate for Payer: Molina Healthcare Passport |
$161.11
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$521.50
|
| Rate for Payer: UHCCP Medicaid |
$104.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.72
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$523.90 |
| Max. Negotiated Rate |
$3,868.80 |
| Rate for Payer: Aetna Commercial |
$3,103.10
|
| Rate for Payer: Anthem Medicaid |
$1,385.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$3,344.90
|
| Rate for Payer: First Health Commercial |
$3,828.50
|
| Rate for Payer: Humana Commercial |
$3,425.50
|
| Rate for Payer: Humana KY Medicaid |
$1,385.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,400.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,304.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,413.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,546.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,022.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.30
|
| Rate for Payer: PHCS Commercial |
$3,868.80
|
| Rate for Payer: United Healthcare All Payer |
$3,546.40
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$523.90 |
| Max. Negotiated Rate |
$3,868.80 |
| Rate for Payer: Aetna Commercial |
$3,103.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.40
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$3,344.90
|
| Rate for Payer: First Health Commercial |
$3,828.50
|
| Rate for Payer: Humana Commercial |
$3,425.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,304.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,209.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,546.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,022.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.30
|
| Rate for Payer: PHCS Commercial |
$3,868.80
|
| Rate for Payer: United Healthcare All Payer |
$3,546.40
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Professional
|
Both
|
$4,030.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$4,030.00 |
| Rate for Payer: Aetna Commercial |
$242.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.62
|
| Rate for Payer: Anthem Medicaid |
$186.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,030.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$219.64
|
| Rate for Payer: Healthspan PPO |
$383.12
|
| Rate for Payer: Humana Medicaid |
$186.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.90
|
| Rate for Payer: Molina Healthcare Passport |
$186.18
|
| Rate for Payer: Multiplan PHCS |
$2,418.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,821.00
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.04
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
45000219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
761T1169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.57 |
| Max. Negotiated Rate |
$3,541.44 |
| Rate for Payer: Aetna Commercial |
$2,840.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.42
|
| Rate for Payer: Cash Price |
$1,844.50
|
| Rate for Payer: Cigna Commercial |
$3,061.87
|
| Rate for Payer: First Health Commercial |
$3,504.55
|
| Rate for Payer: Humana Commercial |
$3,135.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.59
|
| Rate for Payer: PHCS Commercial |
$3,541.44
|
| Rate for Payer: United Healthcare All Payer |
$3,246.32
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
761P1169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$383.12 |
| Rate for Payer: Aetna Commercial |
$242.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.62
|
| Rate for Payer: Anthem Medicaid |
$186.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$341.00
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$219.64
|
| Rate for Payer: Healthspan PPO |
$383.12
|
| Rate for Payer: Humana Medicaid |
$186.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.90
|
| Rate for Payer: Molina Healthcare Passport |
$186.18
|
| Rate for Payer: Multiplan PHCS |
$204.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.70
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.04
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
761T1169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.57 |
| Max. Negotiated Rate |
$3,541.44 |
| Rate for Payer: Aetna Commercial |
$2,840.53
|
| Rate for Payer: Anthem Medicaid |
$1,268.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,844.50
|
| Rate for Payer: Cash Price |
$1,844.50
|
| Rate for Payer: Cigna Commercial |
$3,061.87
|
| Rate for Payer: First Health Commercial |
$3,504.55
|
| Rate for Payer: Humana Commercial |
$3,135.65
|
| Rate for Payer: Humana KY Medicaid |
$1,268.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.59
|
| Rate for Payer: PHCS Commercial |
$3,541.44
|
| Rate for Payer: United Healthcare All Payer |
$3,246.32
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
45000219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$2,054.81 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,467.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,054.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,981.42
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,467.72
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.16
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
IP
|
$8,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
76101170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.96 |
| Max. Negotiated Rate |
$8,440.32 |
| Rate for Payer: Aetna Commercial |
$6,769.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,857.76
|
| Rate for Payer: Cash Price |
$4,396.00
|
| Rate for Payer: Cigna Commercial |
$7,297.36
|
| Rate for Payer: First Health Commercial |
$8,352.40
|
| Rate for Payer: Humana Commercial |
$7,473.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,209.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,488.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,637.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,736.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,594.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.52
|
| Rate for Payer: PHCS Commercial |
$8,440.32
|
| Rate for Payer: United Healthcare All Payer |
$7,736.96
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Professional
|
Both
|
$8,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
76101170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$8,792.00 |
| Rate for Payer: Aetna Commercial |
$387.62
|
| Rate for Payer: Anthem Medicaid |
$245.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,792.00
|
| Rate for Payer: Cash Price |
$4,396.00
|
| Rate for Payer: Cash Price |
$4,396.00
|
| Rate for Payer: Cigna Commercial |
$351.74
|
| Rate for Payer: Healthspan PPO |
$302.64
|
| Rate for Payer: Humana Medicaid |
$245.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.48
|
| Rate for Payer: Molina Healthcare Passport |
$245.57
|
| Rate for Payer: Multiplan PHCS |
$5,275.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,154.40
|
| Rate for Payer: UHCCP Medicaid |
$3,077.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.03
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
761P1170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$387.62
|
| Rate for Payer: Anthem Medicaid |
$245.57
|
| 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 |
$351.74
|
| Rate for Payer: Healthspan PPO |
$302.64
|
| Rate for Payer: Humana Medicaid |
$245.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.48
|
| Rate for Payer: Molina Healthcare Passport |
$245.57
|
| 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 |
$248.03
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
IP
|
$7,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
761T1170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,012.96 |
| Max. Negotiated Rate |
$7,480.32 |
| Rate for Payer: Aetna Commercial |
$5,999.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,077.76
|
| Rate for Payer: Cash Price |
$3,896.00
|
| Rate for Payer: Cigna Commercial |
$6,467.36
|
| Rate for Payer: First Health Commercial |
$7,402.40
|
| Rate for Payer: Humana Commercial |
$6,623.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,389.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,750.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,856.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,844.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.52
|
| Rate for Payer: PHCS Commercial |
$7,480.32
|
| Rate for Payer: United Healthcare All Payer |
$6,856.96
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
OP
|
$7,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
761T1170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,012.96 |
| Max. Negotiated Rate |
$8,286.08 |
| Rate for Payer: Aetna Commercial |
$5,999.84
|
| Rate for Payer: Anthem Medicaid |
$2,679.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,918.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,077.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,286.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,990.15
|
| Rate for Payer: Cash Price |
$3,896.00
|
| Rate for Payer: Cash Price |
$3,896.00
|
| Rate for Payer: Cigna Commercial |
$6,467.36
|
| Rate for Payer: First Health Commercial |
$7,402.40
|
| Rate for Payer: Humana Commercial |
$6,623.20
|
| Rate for Payer: Humana KY Medicaid |
$2,679.67
|
| Rate for Payer: Humana Medicare Advantage |
$5,918.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,389.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,750.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,102.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,733.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,856.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,844.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.52
|
| Rate for Payer: PHCS Commercial |
$7,480.32
|
| Rate for Payer: United Healthcare All Payer |
$6,856.96
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
OP
|
$8,124.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
45000220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,056.12 |
| Max. Negotiated Rate |
$8,286.08 |
| Rate for Payer: Aetna Commercial |
$6,255.48
|
| Rate for Payer: Anthem Medicaid |
$2,793.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,918.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,336.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,286.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,990.15
|
| Rate for Payer: Cash Price |
$4,062.00
|
| Rate for Payer: Cash Price |
$4,062.00
|
| Rate for Payer: Cigna Commercial |
$6,742.92
|
| Rate for Payer: First Health Commercial |
$7,717.80
|
| Rate for Payer: Humana Commercial |
$6,905.40
|
| Rate for Payer: Humana KY Medicaid |
$2,793.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,918.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,822.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,661.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,995.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,102.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,849.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,149.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,093.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.44
|
| Rate for Payer: PHCS Commercial |
$7,799.04
|
| Rate for Payer: United Healthcare All Payer |
$7,149.12
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
OP
|
$8,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
76101170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.96 |
| Max. Negotiated Rate |
$8,440.32 |
| Rate for Payer: Aetna Commercial |
$6,769.84
|
| Rate for Payer: Anthem Medicaid |
$3,023.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,918.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,857.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,286.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,990.15
|
| Rate for Payer: Cash Price |
$4,396.00
|
| Rate for Payer: Cash Price |
$4,396.00
|
| Rate for Payer: Cigna Commercial |
$7,297.36
|
| Rate for Payer: First Health Commercial |
$8,352.40
|
| Rate for Payer: Humana Commercial |
$7,473.20
|
| Rate for Payer: Humana KY Medicaid |
$3,023.57
|
| Rate for Payer: Humana Medicare Advantage |
$5,918.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,054.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,209.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,488.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,102.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,084.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,736.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,594.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.52
|
| Rate for Payer: PHCS Commercial |
$8,440.32
|
| Rate for Payer: United Healthcare All Payer |
$7,736.96
|
|
