|
BRONCHOSCOPY BRONCH STENTS
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 31636
|
| Hospital Charge Code |
41000046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$135.90 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
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 |
$378.11 |
| Rate for Payer: Aetna Commercial |
$378.11
|
| Rate for Payer: Ambetter Exchange |
$202.87
|
| Rate for Payer: Anthem Medicaid |
$180.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$202.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.87
|
| 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 |
$263.73
|
| Rate for Payer: UHCCP Medicaid |
$158.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.87
|
|
|
BRONCHOSCOPY BRONCH STENTS
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 31636
|
| Hospital Charge Code |
41000046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$155.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| 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 |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$155.79
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$157.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
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 |
$378.11 |
| Rate for Payer: Aetna Commercial |
$378.11
|
| Rate for Payer: Ambetter Exchange |
$202.87
|
| Rate for Payer: Anthem Medicaid |
$180.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$202.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.87
|
| 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 |
$263.73
|
| Rate for Payer: UHCCP Medicaid |
$158.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.87
|
|
|
BRONCHOSCOPY DILATE/FX REPR
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 31630
|
| Hospital Charge Code |
41000042
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$319.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.70
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: First Health Commercial |
$394.25
|
| Rate for Payer: Humana Commercial |
$352.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$340.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$306.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$365.20
|
| Rate for Payer: Ohio Health Group HMO |
$311.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.35
|
| Rate for Payer: PHCS Commercial |
$398.40
|
| Rate for Payer: United Healthcare All Payer |
$365.20
|
|
|
BRONCHOSCOPY DILATE/FX REPR
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 31630
|
| Hospital Charge Code |
41000042
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$142.72 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Aetna Commercial |
$319.55
|
| Rate for Payer: Anthem Medicaid |
$142.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.70
|
| 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 |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: First Health Commercial |
$394.25
|
| Rate for Payer: Humana Commercial |
$352.75
|
| Rate for Payer: Humana KY Medicaid |
$142.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,406.67
|
| Rate for Payer: Kentucky WC Medicaid |
$144.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$340.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$306.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$365.20
|
| Rate for Payer: Ohio Health Group HMO |
$311.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.35
|
| Rate for Payer: PHCS Commercial |
$398.40
|
| Rate for Payer: United Healthcare All Payer |
$365.20
|
|
|
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 |
$344.27 |
| Rate for Payer: Aetna Commercial |
$344.27
|
| Rate for Payer: Ambetter Exchange |
$185.21
|
| Rate for Payer: Anthem Medicaid |
$224.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.25
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$185.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.21
|
| 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 |
$240.77
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.21
|
|
|
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 |
$344.27 |
| Rate for Payer: Aetna Commercial |
$344.27
|
| Rate for Payer: Ambetter Exchange |
$185.21
|
| Rate for Payer: Anthem Medicaid |
$224.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.25
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$185.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.21
|
| 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 |
$240.77
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.21
|
|
|
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: Ambetter Exchange |
$163.12
|
| 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 Individual/Medicaid |
$163.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.12
|
| 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 |
$212.06
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.12
|
|
|
BRONCHOSCOPY/LUNG BX EACH
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$430.08 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.44
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$371.84
|
| Rate for Payer: First Health Commercial |
$425.60
|
| Rate for Payer: Humana Commercial |
$380.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.24
|
| Rate for Payer: Ohio Health Group HMO |
$336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$389.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.12
|
| Rate for Payer: PHCS Commercial |
$430.08
|
| Rate for Payer: United Healthcare All Payer |
$394.24
|
|
|
BRONCHOSCOPY/LUNG BX EACH
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: Anthem Medicaid |
$154.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.44
|
| 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 |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$371.84
|
| Rate for Payer: First Health Commercial |
$425.60
|
| Rate for Payer: Humana Commercial |
$380.80
|
| Rate for Payer: Humana KY Medicaid |
$154.07
|
| Rate for Payer: Humana Medicare Advantage |
$3,406.67
|
| Rate for Payer: Kentucky WC Medicaid |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.24
|
| Rate for Payer: Ohio Health Group HMO |
$336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$389.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.12
|
| Rate for Payer: PHCS Commercial |
$430.08
|
| Rate for Payer: United Healthcare All Payer |
$394.24
|
|
|
BRONCHOSCOPY/LUNG BX EACH(P
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
410P0040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$503.64 |
| Rate for Payer: Aetna Commercial |
$318.44
|
| Rate for Payer: Ambetter Exchange |
$163.12
|
| 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 Individual/Medicaid |
$163.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.12
|
| 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 |
$212.06
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.12
|
|
|
BRONCHOSCOPY/NEEDLE BX ADDL
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 31633
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
BRONCHOSCOPY/NEEDLE BX ADDL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 31633
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$117.19 |
| Rate for Payer: Aetna Commercial |
$114.26
|
| Rate for Payer: Ambetter Exchange |
$58.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$65.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$102.90
|
| Rate for Payer: Healthspan PPO |
$117.19
|
| Rate for Payer: Humana Medicaid |
$65.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.06
|
| Rate for Payer: Molina Healthcare Passport |
$65.75
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.48
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.83
|
|
|
BRONCHOSCOPY/NEEDLE BX ADDL
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 31633
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
BRONCHOSCOPY/NEEDLE BX ADDL(P
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 31633
|
| Hospital Charge Code |
410P0044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$117.19 |
| Rate for Payer: Aetna Commercial |
$114.26
|
| Rate for Payer: Ambetter Exchange |
$58.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$65.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$102.90
|
| Rate for Payer: Healthspan PPO |
$117.19
|
| Rate for Payer: Humana Medicaid |
$65.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.06
|
| Rate for Payer: Molina Healthcare Passport |
$65.75
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.48
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.83
|
|
|
BRONCHOSCOPY/NEEDLE BX EACH
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
41000041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$762.10 |
| Rate for Payer: Aetna Commercial |
$339.60
|
| Rate for Payer: Ambetter Exchange |
$173.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.35
|
| Rate for Payer: Anthem Medicaid |
$222.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$208.79
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$308.63
|
| Rate for Payer: Healthspan PPO |
$762.10
|
| Rate for Payer: Humana Medicaid |
$222.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.21
|
| Rate for Payer: Molina Healthcare Passport |
$222.75
|
| Rate for Payer: Multiplan PHCS |
$406.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.19
|
| Rate for Payer: UHCCP Medicaid |
$134.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.99
|
|
|
BRONCHOSCOPY/NEEDLE BX EACH
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
41000041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$203.10 |
| Max. Negotiated Rate |
$649.92 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$528.06
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$561.91
|
| Rate for Payer: First Health Commercial |
$643.15
|
| Rate for Payer: Humana Commercial |
$575.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$555.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$499.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$595.76
|
| Rate for Payer: Ohio Health Group HMO |
$507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$467.13
|
| Rate for Payer: PHCS Commercial |
$649.92
|
| Rate for Payer: United Healthcare All Payer |
$595.76
|
|
|
BRONCHOSCOPY/NEEDLE BX EACH
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
41000041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$232.82 |
| Max. Negotiated Rate |
$4,769.34 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Anthem Medicaid |
$232.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,406.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$528.06
|
| 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 |
$338.50
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$561.91
|
| Rate for Payer: First Health Commercial |
$643.15
|
| Rate for Payer: Humana Commercial |
$575.45
|
| Rate for Payer: Humana KY Medicaid |
$232.82
|
| Rate for Payer: Humana Medicare Advantage |
$3,406.67
|
| Rate for Payer: Kentucky WC Medicaid |
$235.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$555.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$499.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$237.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$595.76
|
| Rate for Payer: Ohio Health Group HMO |
$507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$467.13
|
| Rate for Payer: PHCS Commercial |
$649.92
|
| Rate for Payer: United Healthcare All Payer |
$595.76
|
|
|
BRONCHOSCOPY/NEEDLE BX EACH(P
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
410P0041
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$762.10 |
| Rate for Payer: Aetna Commercial |
$339.60
|
| Rate for Payer: Ambetter Exchange |
$173.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.35
|
| Rate for Payer: Anthem Medicaid |
$222.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$208.79
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$308.63
|
| Rate for Payer: Healthspan PPO |
$762.10
|
| Rate for Payer: Humana Medicaid |
$222.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.21
|
| Rate for Payer: Molina Healthcare Passport |
$222.75
|
| Rate for Payer: Multiplan PHCS |
$406.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.19
|
| Rate for Payer: UHCCP Medicaid |
$134.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.99
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31622
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL THERMOPLASTY, 1 LOBE
|
Facility
|
OP
|
$8,954.71
|
|
|
Service Code
|
CPT 31660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,396.22 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
|
|
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
|
Facility
|
OP
|
$2,230.73
|
|
|
Service Code
|
CPT 31623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,593.38 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
|
