|
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: Ambetter Exchange |
$57.87
|
| Rate for Payer: Anthem Medicaid |
$68.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$57.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.87
|
| 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 |
$75.23
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.87
|
|
|
BRONCHIAL PROVOCATION TEST(T
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
460T0003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.76 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$165.76
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.58
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
BRONCHIAL PROVOCATION TEST(T
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
460T0003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.58
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
BRONCHIAL VALVE ADDL INSERT
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
41000055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Ambetter Exchange |
$70.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$70.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.56
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.73
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.56
|
|
|
BRONCHIAL VALVE ADDL INSERT
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
41000055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Kentucky WC Medicaid |
$95.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
BRONCHIAL VALVE ADDL INSERT
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
41000055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
BRONCHIAL VALVE ADDL INSERT(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 31651
|
| Hospital Charge Code |
410P0055
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Ambetter Exchange |
$70.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$70.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.56
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.73
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.56
|
|
|
BRONCHIAL VALVE INIT INSERT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
41000054
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
BRONCHIAL VALVE INIT INSERT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
41000054
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
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 |
$395.50 |
| Rate for Payer: Ambetter Exchange |
$191.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.14
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.48
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.14
|
|
|
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 |
$395.50 |
| Rate for Payer: Ambetter Exchange |
$191.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.14
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.48
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.14
|
|
|
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 |
$411.71 |
| Rate for Payer: Ambetter Exchange |
$183.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$183.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.08
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.08
|
|
|
BRONCHIAL VALVE REMOV INIT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 31648
|
| Hospital Charge Code |
76102901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,769.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,599.00
|
| 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 |
$3,406.67
|
| Rate for Payer: Kentucky WC Medicaid |
$165.01
|
| 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 |
$4,088.00
|
| 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 |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| 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 |
$142.50 |
| 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 |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
BRONCHIAL WASHING CELL COUNT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
BRONCHIAL WASHING CELL COUNT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| 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 |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
BRONCHOGRAPHY
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
32000188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| 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 |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| 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 |
$81.36
|
| 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 |
$97.63
|
| 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 |
$691.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$751.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.16
|
| 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 |
$604.80 |
| 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 |
$259.20 |
| 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 |
$691.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$751.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.16
|
| 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 |
$259.20 |
| 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 |
$691.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$751.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.16
|
| 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 |
$81.36 |
| 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 |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| 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 |
$81.36
|
| 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 |
$97.63
|
| 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 |
$691.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$751.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.16
|
| Rate for Payer: PHCS Commercial |
$829.44
|
| Rate for Payer: United Healthcare All Payer |
$760.32
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
76101194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$228.41 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$428.49
|
| Rate for Payer: Ambetter Exchange |
$228.41
|
| Rate for Payer: Anthem Medicaid |
$270.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.09
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$228.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.41
|
| 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 |
$296.93
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.41
|
|
|
BRONCHOPLASTY/REPAIR PL FISTUL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32501
|
| Hospital Charge Code |
761P1194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.41 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$428.49
|
| Rate for Payer: Ambetter Exchange |
$228.41
|
| Rate for Payer: Anthem Medicaid |
$270.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$274.09
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$228.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.41
|
| 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 |
$296.93
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.41
|
|
