Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCISION (EG, LASER THERAPY, CRYOTHERAPY)

Facility

$4,769.34

Service Code	CPT 31641
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES

Facility

$4,769.34

Service Code	CPT 31653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES

Facility

$4,769.34

Service Code	CPT 31652
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH EXCISION OF TUMOR

Facility

$4,769.34

Service Code	CPT 31640
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MULTIPLE

Facility

$8,954.71

Service Code	CPT 31626
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 PLACEMENT OF TRACHEAL STENT(S) (INCLUDES TRACHEAL/BRONCHIAL DILATION AS REQUIRED)

Facility

$8,954.71

Service Code	CPT 31631
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 REMOVAL OF FOREIGN BODY

Facility

$2,230.73

Service Code	CPT 31635
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 THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL

Facility

$2,230.73

Service Code	CPT 31645
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 TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE

Facility

$4,769.34

Service Code	CPT 31630
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE

Facility

$4,769.34

Service Code	CPT 31628
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), TRACHEA, MAIN STEM AND/OR LOBAR BRONCHUS(I)

Facility

$4,769.34

Service Code	CPT 31629
Hospital Revenue Code	360
Min. Negotiated Rate	$3,406.67
Max. Negotiated Rate	$4,769.34
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,769.34
Rate for Payer: CareSource Just4Me Medicare	$4,599.00
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00

BRONCHOSCOPY TREAT BLOCKAGE

Facility

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	41000050
Hospital Revenue Code	410
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$495.36
Rate for Payer: Aetna Commercial	$397.32
Rate for Payer: Anthem POS/PPO/Traditional	$402.48
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$428.28
Rate for Payer: First Health Commercial	$490.20
Rate for Payer: Humana Commercial	$438.60
Rate for Payer: Medical Mutual Of Ohio HMO	$423.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$380.81
Rate for Payer: Molina Healthcare Benefit Exchange	$154.80
Rate for Payer: Ohio Health Choice Commercial	$454.08
Rate for Payer: Ohio Health Group HMO	$387.00
Rate for Payer: Ohio Health Group PPO Differential	$412.80
Rate for Payer: Ohio Health Group PPO No Differential	$448.92
Rate for Payer: Ohio Health Group PPO SOMC Employees	$356.04
Rate for Payer: PHCS Commercial	$495.36
Rate for Payer: United Healthcare All Payer	$454.08

BRONCHOSCOPY TREAT BLOCKAGE

Professional

Both

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	41000050
Hospital Revenue Code	410
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$434.17
Rate for Payer: Aetna Commercial	$434.17
Rate for Payer: Ambetter Exchange	$235.07
Rate for Payer: Anthem Medicaid	$341.25
Rate for Payer: Buckeye Individual/Medicaid	$235.07
Rate for Payer: Buckeye Medicare Advantage	$235.07
Rate for Payer: CareSource Just4Me Medicare	$282.08
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$394.85
Rate for Payer: Healthspan PPO	$338.99
Rate for Payer: Humana Medicaid	$341.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$335.82
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$235.07
Rate for Payer: Molina Healthcare Benefit Exchange	$235.07
Rate for Payer: Molina Healthcare CHIP/Medicaid	$348.07
Rate for Payer: Molina Healthcare Passport	$341.25
Rate for Payer: Multiplan PHCS	$309.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$305.59
Rate for Payer: UHCCP Medicaid	$180.60
Rate for Payer: Wellcare CHIP/Medicaid	$344.66
Rate for Payer: Wellcare Medicare Advantage	$235.07

BRONCHOSCOPY TREAT BLOCKAGE

Facility

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	41000050
Hospital Revenue Code	410
Min. Negotiated Rate	$177.45
Max. Negotiated Rate	$4,769.34
Rate for Payer: Aetna Commercial	$397.32
Rate for Payer: Anthem Medicaid	$177.45
Rate for Payer: Anthem Medicare Advantage/PPO	$3,406.67
Rate for Payer: Anthem POS/PPO/Traditional	$402.48
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	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$428.28
Rate for Payer: First Health Commercial	$490.20
Rate for Payer: Humana Commercial	$438.60
Rate for Payer: Humana KY Medicaid	$177.45
Rate for Payer: Humana Medicare Advantage	$3,406.67
Rate for Payer: Kentucky WC Medicaid	$179.26
Rate for Payer: Medical Mutual Of Ohio HMO	$423.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$380.81
Rate for Payer: Molina Healthcare Benefit Exchange	$4,088.00
Rate for Payer: Molina Healthcare Medicaid	$181.01
Rate for Payer: Ohio Health Choice Commercial	$454.08
Rate for Payer: Ohio Health Group HMO	$387.00
Rate for Payer: Ohio Health Group PPO Differential	$412.80
Rate for Payer: Ohio Health Group PPO No Differential	$448.92
Rate for Payer: Ohio Health Group PPO SOMC Employees	$356.04
Rate for Payer: PHCS Commercial	$495.36
Rate for Payer: United Healthcare All Payer	$454.08

BRONCHOSCOPY TREAT BLOCKAGE(P

Professional

Both

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	410P0050
Hospital Revenue Code	410
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$434.17
Rate for Payer: Aetna Commercial	$434.17
Rate for Payer: Ambetter Exchange	$235.07
Rate for Payer: Anthem Medicaid	$341.25
Rate for Payer: Buckeye Individual/Medicaid	$235.07
Rate for Payer: Buckeye Medicare Advantage	$235.07
Rate for Payer: CareSource Just4Me Medicare	$282.08
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$394.85
Rate for Payer: Healthspan PPO	$338.99
Rate for Payer: Humana Medicaid	$341.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$335.82
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$235.07
Rate for Payer: Molina Healthcare Benefit Exchange	$235.07
Rate for Payer: Molina Healthcare CHIP/Medicaid	$348.07
Rate for Payer: Molina Healthcare Passport	$341.25
Rate for Payer: Multiplan PHCS	$309.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$305.59
Rate for Payer: UHCCP Medicaid	$180.60
Rate for Payer: Wellcare CHIP/Medicaid	$344.66
Rate for Payer: Wellcare Medicare Advantage	$235.07

BRONCHOSCOPY W/BIOPSY(S)

Professional

Both

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$79.08
Max. Negotiated Rate	$420.84
Rate for Payer: Aetna Commercial	$285.80
Rate for Payer: Ambetter Exchange	$145.06
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$79.08
Rate for Payer: Anthem Medicaid	$210.12
Rate for Payer: Buckeye Individual/Medicaid	$145.06
Rate for Payer: Buckeye Medicare Advantage	$145.06
Rate for Payer: CareSource Just4Me Medicare	$174.07
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: Healthspan PPO	$420.84
Rate for Payer: Humana Medicaid	$210.12
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$219.32
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$145.06
Rate for Payer: Molina Healthcare Benefit Exchange	$145.06
Rate for Payer: Molina Healthcare CHIP/Medicaid	$214.32
Rate for Payer: Molina Healthcare Passport	$210.12
Rate for Payer: Multiplan PHCS	$224.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.58
Rate for Payer: UHCCP Medicaid	$83.03
Rate for Payer: Wellcare CHIP/Medicaid	$212.22
Rate for Payer: Wellcare Medicare Advantage	$145.06

BRONCHOSCOPY W/BIOPSY(S)

Facility

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$2,230.73
Rate for Payer: Aetna Commercial	$287.98
Rate for Payer: Anthem Medicaid	$128.62
Rate for Payer: Anthem Medicare Advantage/PPO	$1,593.38
Rate for Payer: Anthem POS/PPO/Traditional	$291.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,230.73
Rate for Payer: CareSource Just4Me Medicare	$2,151.06
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$310.42
Rate for Payer: First Health Commercial	$355.30
Rate for Payer: Humana Commercial	$317.90
Rate for Payer: Humana KY Medicaid	$128.62
Rate for Payer: Humana Medicare Advantage	$1,593.38
Rate for Payer: Kentucky WC Medicaid	$129.93
Rate for Payer: Medical Mutual Of Ohio HMO	$306.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$276.01
Rate for Payer: Molina Healthcare Benefit Exchange	$1,912.06
Rate for Payer: Molina Healthcare Medicaid	$131.20
Rate for Payer: Ohio Health Choice Commercial	$329.12
Rate for Payer: Ohio Health Group HMO	$280.50
Rate for Payer: Ohio Health Group PPO Differential	$299.20
Rate for Payer: Ohio Health Group PPO No Differential	$325.38
Rate for Payer: Ohio Health Group PPO SOMC Employees	$258.06
Rate for Payer: PHCS Commercial	$359.04
Rate for Payer: United Healthcare All Payer	$329.12

BRONCHOSCOPY W/BIOPSY(S)

Facility

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$359.04
Rate for Payer: Aetna Commercial	$287.98
Rate for Payer: Anthem POS/PPO/Traditional	$291.72
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$310.42
Rate for Payer: First Health Commercial	$355.30
Rate for Payer: Humana Commercial	$317.90
Rate for Payer: Medical Mutual Of Ohio HMO	$306.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$276.01
Rate for Payer: Molina Healthcare Benefit Exchange	$112.20
Rate for Payer: Ohio Health Choice Commercial	$329.12
Rate for Payer: Ohio Health Group HMO	$280.50
Rate for Payer: Ohio Health Group PPO Differential	$299.20
Rate for Payer: Ohio Health Group PPO No Differential	$325.38
Rate for Payer: Ohio Health Group PPO SOMC Employees	$258.06
Rate for Payer: PHCS Commercial	$359.04
Rate for Payer: United Healthcare All Payer	$329.12

BRONCHOSCOPY W/BIOPSY(S)(P

Professional

Both

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	410P0037
Hospital Revenue Code	410
Min. Negotiated Rate	$79.08
Max. Negotiated Rate	$420.84
Rate for Payer: Aetna Commercial	$285.80
Rate for Payer: Ambetter Exchange	$145.06
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$79.08
Rate for Payer: Anthem Medicaid	$210.12
Rate for Payer: Buckeye Individual/Medicaid	$145.06
Rate for Payer: Buckeye Medicare Advantage	$145.06
Rate for Payer: CareSource Just4Me Medicare	$174.07
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: Healthspan PPO	$420.84
Rate for Payer: Humana Medicaid	$210.12
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$219.32
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$145.06
Rate for Payer: Molina Healthcare Benefit Exchange	$145.06
Rate for Payer: Molina Healthcare CHIP/Medicaid	$214.32
Rate for Payer: Molina Healthcare Passport	$210.12
Rate for Payer: Multiplan PHCS	$224.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.58
Rate for Payer: UHCCP Medicaid	$83.03
Rate for Payer: Wellcare CHIP/Medicaid	$212.22
Rate for Payer: Wellcare Medicare Advantage	$145.06

BRONCHOSCOPY W FOREIGN BODY

Facility

$4,622.00

Service Code	HCPCS 31635
Hospital Charge Code	76101171
Hospital Revenue Code	761
Min. Negotiated Rate	$1,386.60
Max. Negotiated Rate	$4,437.12
Rate for Payer: Aetna Commercial	$3,558.94
Rate for Payer: Anthem POS/PPO/Traditional	$3,605.16
Rate for Payer: Cash Price	$2,311.00
Rate for Payer: Cigna Commercial	$3,836.26
Rate for Payer: First Health Commercial	$4,390.90
Rate for Payer: Humana Commercial	$3,928.70
Rate for Payer: Medical Mutual Of Ohio HMO	$3,790.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,411.04
Rate for Payer: Molina Healthcare Benefit Exchange	$1,386.60
Rate for Payer: Ohio Health Choice Commercial	$4,067.36
Rate for Payer: Ohio Health Group HMO	$3,466.50
Rate for Payer: Ohio Health Group PPO Differential	$3,697.60
Rate for Payer: Ohio Health Group PPO No Differential	$4,021.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,189.18
Rate for Payer: PHCS Commercial	$4,437.12
Rate for Payer: United Healthcare All Payer	$4,067.36

BRONCHOSCOPY W FOREIGN BODY

Facility

$4,622.00

Service Code	HCPCS 31635
Hospital Charge Code	76101171
Hospital Revenue Code	761
Min. Negotiated Rate	$1,589.51
Max. Negotiated Rate	$4,437.12
Rate for Payer: Aetna Commercial	$3,558.94
Rate for Payer: Anthem Medicaid	$1,589.51
Rate for Payer: Anthem Medicare Advantage/PPO	$1,593.38
Rate for Payer: Anthem POS/PPO/Traditional	$3,605.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,230.73
Rate for Payer: CareSource Just4Me Medicare	$2,151.06
Rate for Payer: Cash Price	$2,311.00
Rate for Payer: Cash Price	$2,311.00
Rate for Payer: Cigna Commercial	$3,836.26
Rate for Payer: First Health Commercial	$4,390.90
Rate for Payer: Humana Commercial	$3,928.70
Rate for Payer: Humana KY Medicaid	$1,589.51
Rate for Payer: Humana Medicare Advantage	$1,593.38
Rate for Payer: Kentucky WC Medicaid	$1,605.68
Rate for Payer: Medical Mutual Of Ohio HMO	$3,790.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,411.04
Rate for Payer: Molina Healthcare Benefit Exchange	$1,912.06
Rate for Payer: Molina Healthcare Medicaid	$1,621.40
Rate for Payer: Ohio Health Choice Commercial	$4,067.36
Rate for Payer: Ohio Health Group HMO	$3,466.50
Rate for Payer: Ohio Health Group PPO Differential	$3,697.60
Rate for Payer: Ohio Health Group PPO No Differential	$4,021.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,189.18
Rate for Payer: PHCS Commercial	$4,437.12
Rate for Payer: United Healthcare All Payer	$4,067.36

BRONCHOSCOPY W FOREIGN BODY

Facility

$3,622.00

Service Code	HCPCS 31635
Hospital Charge Code	45000221
Hospital Revenue Code	450
Min. Negotiated Rate	$1,245.61
Max. Negotiated Rate	$3,477.12
Rate for Payer: Aetna Commercial	$2,788.94
Rate for Payer: Anthem Medicaid	$1,245.61
Rate for Payer: Anthem Medicare Advantage/PPO	$1,593.38
Rate for Payer: Anthem POS/PPO/Traditional	$2,825.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,230.73
Rate for Payer: CareSource Just4Me Medicare	$2,151.06
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cigna Commercial	$3,006.26
Rate for Payer: First Health Commercial	$3,440.90
Rate for Payer: Humana Commercial	$3,078.70
Rate for Payer: Humana KY Medicaid	$1,245.61
Rate for Payer: Humana Medicare Advantage	$1,593.38
Rate for Payer: Kentucky WC Medicaid	$1,258.28
Rate for Payer: Medical Mutual Of Ohio HMO	$2,970.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,673.04
Rate for Payer: Molina Healthcare Benefit Exchange	$1,912.06
Rate for Payer: Molina Healthcare Medicaid	$1,270.60
Rate for Payer: Ohio Health Choice Commercial	$3,187.36
Rate for Payer: Ohio Health Group HMO	$2,716.50
Rate for Payer: Ohio Health Group PPO Differential	$2,897.60
Rate for Payer: Ohio Health Group PPO No Differential	$3,151.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,499.18
Rate for Payer: PHCS Commercial	$3,477.12
Rate for Payer: United Healthcare All Payer	$3,187.36

BRONCHOSCOPY W FOREIGN BODY

Facility

$3,622.00

Service Code	HCPCS 31635
Hospital Charge Code	45000221
Hospital Revenue Code	450
Min. Negotiated Rate	$1,086.60
Max. Negotiated Rate	$3,477.12
Rate for Payer: Aetna Commercial	$2,788.94
Rate for Payer: Anthem POS/PPO/Traditional	$2,825.16
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cigna Commercial	$3,006.26
Rate for Payer: First Health Commercial	$3,440.90
Rate for Payer: Humana Commercial	$3,078.70
Rate for Payer: Medical Mutual Of Ohio HMO	$2,970.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,673.04
Rate for Payer: Molina Healthcare Benefit Exchange	$1,086.60
Rate for Payer: Ohio Health Choice Commercial	$3,187.36
Rate for Payer: Ohio Health Group HMO	$2,716.50
Rate for Payer: Ohio Health Group PPO Differential	$2,897.60
Rate for Payer: Ohio Health Group PPO No Differential	$3,151.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,499.18
Rate for Payer: PHCS Commercial	$3,477.12
Rate for Payer: United Healthcare All Payer	$3,187.36

BRONCHOSCOPY W FOREIGN BODY

Professional

Both

$4,622.00

Service Code	HCPCS 31635
Hospital Charge Code	76101171
Hospital Revenue Code	761
Min. Negotiated Rate	$88.59
Max. Negotiated Rate	$2,773.20
Rate for Payer: Aetna Commercial	$318.41
Rate for Payer: Ambetter Exchange	$163.32
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 Individual/Medicaid	$163.32
Rate for Payer: Buckeye Medicare Advantage	$163.32
Rate for Payer: CareSource Just4Me Medicare	$195.98
Rate for Payer: Cash Price	$2,311.00
Rate for Payer: Cash Price	$2,311.00
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: Medical Mutual Of Ohio Medicare Advantage	$163.32
Rate for Payer: Molina Healthcare Benefit Exchange	$163.32
Rate for Payer: Molina Healthcare CHIP/Medicaid	$247.22
Rate for Payer: Molina Healthcare Passport	$242.37
Rate for Payer: Multiplan PHCS	$2,773.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$212.32
Rate for Payer: UHCCP Medicaid	$93.02
Rate for Payer: Wellcare CHIP/Medicaid	$244.79
Rate for Payer: Wellcare Medicare Advantage	$163.32

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	$600.00
Rate for Payer: Aetna Commercial	$318.41
Rate for Payer: Ambetter Exchange	$163.32
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 Individual/Medicaid	$163.32
Rate for Payer: Buckeye Medicare Advantage	$163.32
Rate for Payer: CareSource Just4Me Medicare	$195.98
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: Medical Mutual Of Ohio Medicare Advantage	$163.32
Rate for Payer: Molina Healthcare Benefit Exchange	$163.32
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	$212.32
Rate for Payer: UHCCP Medicaid	$93.02
Rate for Payer: Wellcare CHIP/Medicaid	$244.79
Rate for Payer: Wellcare Medicare Advantage	$163.32

Know your out-of-pocket cost for care.

All Charges