|
BRONCHOSCOPY W FOREIGN BODY(T
|
Facility
|
IP
|
$3,622.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
761T1171
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
OP
|
$3,622.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
761T1171
|
|
Hospital Revenue Code
|
761
|
| 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/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 |
$447.00 |
| Rate for Payer: Aetna Commercial |
$359.09
|
| Rate for Payer: Ambetter Exchange |
$185.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.32
|
| Rate for Payer: Anthem Medicaid |
$310.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.29
|
| 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 |
$310.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.11
|
| Rate for Payer: Molina Healthcare Passport |
$310.89
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.81
|
| Rate for Payer: UHCCP Medicaid |
$104.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.24
|
|
|
BRONCHOSCOPY W/MARKERS
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 31626
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$256.21 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$573.65
|
| Rate for Payer: Anthem Medicaid |
$256.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.10
|
| 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 |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$618.35
|
| Rate for Payer: First Health Commercial |
$707.75
|
| Rate for Payer: Humana Commercial |
$633.25
|
| Rate for Payer: Humana KY Medicaid |
$256.21
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$258.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$655.60
|
| Rate for Payer: Ohio Health Group HMO |
$558.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.05
|
| Rate for Payer: PHCS Commercial |
$715.20
|
| Rate for Payer: United Healthcare All Payer |
$655.60
|
|
|
BRONCHOSCOPY W/MARKERS
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 31626
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$715.20 |
| Rate for Payer: Aetna Commercial |
$573.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.10
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$618.35
|
| Rate for Payer: First Health Commercial |
$707.75
|
| Rate for Payer: Humana Commercial |
$633.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$655.60
|
| Rate for Payer: Ohio Health Group HMO |
$558.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.05
|
| Rate for Payer: PHCS Commercial |
$715.20
|
| Rate for Payer: United Healthcare All Payer |
$655.60
|
|
|
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 |
$447.00 |
| Rate for Payer: Aetna Commercial |
$359.09
|
| Rate for Payer: Ambetter Exchange |
$185.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.32
|
| Rate for Payer: Anthem Medicaid |
$310.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.29
|
| 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 |
$310.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.11
|
| Rate for Payer: Molina Healthcare Passport |
$310.89
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.81
|
| Rate for Payer: UHCCP Medicaid |
$104.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.24
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Professional
|
Both
|
$4,270.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$2,562.00 |
| Rate for Payer: Aetna Commercial |
$242.69
|
| Rate for Payer: Ambetter Exchange |
$123.35
|
| 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 Individual/Medicaid |
$123.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.02
|
| Rate for Payer: Cash Price |
$2,135.00
|
| Rate for Payer: Cash Price |
$2,135.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$123.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.90
|
| Rate for Payer: Molina Healthcare Passport |
$186.18
|
| Rate for Payer: Multiplan PHCS |
$2,562.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$160.35
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.35
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$3,929.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
761T1169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,178.70 |
| Max. Negotiated Rate |
$3,771.84 |
| Rate for Payer: Aetna Commercial |
$3,025.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.62
|
| Rate for Payer: Cash Price |
$1,964.50
|
| Rate for Payer: Cigna Commercial |
$3,261.07
|
| Rate for Payer: First Health Commercial |
$3,732.55
|
| Rate for Payer: Humana Commercial |
$3,339.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,418.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.01
|
| Rate for Payer: PHCS Commercial |
$3,771.84
|
| Rate for Payer: United Healthcare All Payer |
$3,457.52
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$4,270.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,468.45 |
| Max. Negotiated Rate |
$4,099.20 |
| Rate for Payer: Aetna Commercial |
$3,287.90
|
| Rate for Payer: Anthem Medicaid |
$1,468.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,330.60
|
| 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 |
$2,135.00
|
| Rate for Payer: Cash Price |
$2,135.00
|
| Rate for Payer: Cigna Commercial |
$3,544.10
|
| Rate for Payer: First Health Commercial |
$4,056.50
|
| Rate for Payer: Humana Commercial |
$3,629.50
|
| Rate for Payer: Humana KY Medicaid |
$1,468.45
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,483.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,501.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,151.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,497.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,757.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,946.30
|
| Rate for Payer: PHCS Commercial |
$4,099.20
|
| Rate for Payer: United Healthcare All Payer |
$3,757.60
|
|
|
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: Ambetter Exchange |
$123.35
|
| 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 Individual/Medicaid |
$123.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$123.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.35
|
| 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 |
$160.35
|
| Rate for Payer: UHCCP Medicaid |
$69.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.35
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$3,929.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
761T1169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,351.18 |
| Max. Negotiated Rate |
$3,771.84 |
| Rate for Payer: Aetna Commercial |
$3,025.33
|
| Rate for Payer: Anthem Medicaid |
$1,351.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.62
|
| 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 |
$1,964.50
|
| Rate for Payer: Cash Price |
$1,964.50
|
| Rate for Payer: Cigna Commercial |
$3,261.07
|
| Rate for Payer: First Health Commercial |
$3,732.55
|
| Rate for Payer: Humana Commercial |
$3,339.65
|
| Rate for Payer: Humana KY Medicaid |
$1,351.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,364.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,418.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.01
|
| Rate for Payer: PHCS Commercial |
$3,771.84
|
| Rate for Payer: United Healthcare All Payer |
$3,457.52
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$3,929.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
45000219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,178.70 |
| Max. Negotiated Rate |
$3,771.84 |
| Rate for Payer: Aetna Commercial |
$3,025.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.62
|
| Rate for Payer: Cash Price |
$1,964.50
|
| Rate for Payer: Cigna Commercial |
$3,261.07
|
| Rate for Payer: First Health Commercial |
$3,732.55
|
| Rate for Payer: Humana Commercial |
$3,339.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,418.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.01
|
| Rate for Payer: PHCS Commercial |
$3,771.84
|
| Rate for Payer: United Healthcare All Payer |
$3,457.52
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
IP
|
$4,270.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
76101169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$4,099.20 |
| Rate for Payer: Aetna Commercial |
$3,287.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,330.60
|
| Rate for Payer: Cash Price |
$2,135.00
|
| Rate for Payer: Cigna Commercial |
$3,544.10
|
| Rate for Payer: First Health Commercial |
$4,056.50
|
| Rate for Payer: Humana Commercial |
$3,629.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,501.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,151.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,757.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,946.30
|
| Rate for Payer: PHCS Commercial |
$4,099.20
|
| Rate for Payer: United Healthcare All Payer |
$3,757.60
|
|
|
BRONCH RIGIDFLEX DIAG WCEL WAS
|
Facility
|
OP
|
$3,929.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
45000219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.18 |
| Max. Negotiated Rate |
$3,771.84 |
| Rate for Payer: Aetna Commercial |
$3,025.33
|
| Rate for Payer: Anthem Medicaid |
$1,351.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.62
|
| 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 |
$1,964.50
|
| Rate for Payer: Cash Price |
$1,964.50
|
| Rate for Payer: Cigna Commercial |
$3,261.07
|
| Rate for Payer: First Health Commercial |
$3,732.55
|
| Rate for Payer: Humana Commercial |
$3,339.65
|
| Rate for Payer: Humana KY Medicaid |
$1,351.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,364.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,418.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.01
|
| Rate for Payer: PHCS Commercial |
$3,771.84
|
| Rate for Payer: United Healthcare All Payer |
$3,457.52
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
761P1170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.11 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$387.62
|
| Rate for Payer: Ambetter Exchange |
$211.11
|
| Rate for Payer: Anthem Medicaid |
$245.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$211.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$211.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$211.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.11
|
| 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 |
$274.44
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$211.11
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
IP
|
$8,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
76101170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,637.60 |
| 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 |
$7,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,649.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,066.48
|
| 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 |
$211.11 |
| Max. Negotiated Rate |
$5,275.20 |
| Rate for Payer: Aetna Commercial |
$387.62
|
| Rate for Payer: Ambetter Exchange |
$211.11
|
| Rate for Payer: Anthem Medicaid |
$245.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$211.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$211.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$211.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.11
|
| 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 |
$274.44
|
| Rate for Payer: UHCCP Medicaid |
$3,077.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$211.11
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
OP
|
$8,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
76101170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,023.57 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$6,769.84
|
| Rate for Payer: Anthem Medicaid |
$3,023.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,857.76
|
| 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 |
$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 |
$6,396.22
|
| 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 |
$7,675.46
|
| 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 |
$7,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,649.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,066.48
|
| Rate for Payer: PHCS Commercial |
$8,440.32
|
| Rate for Payer: United Healthcare All Payer |
$7,736.96
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
IP
|
$7,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
45000220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,337.60 |
| 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 |
$6,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,779.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.48
|
| 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 |
$2,679.67 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$5,999.84
|
| Rate for Payer: Anthem Medicaid |
$2,679.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,077.76
|
| 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 |
$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 |
$6,396.22
|
| 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 |
$7,675.46
|
| 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 |
$6,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,779.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.48
|
| 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 |
45000220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,679.67 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$5,999.84
|
| Rate for Payer: Anthem Medicaid |
$2,679.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,077.76
|
| 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 |
$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 |
$6,396.22
|
| 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 |
$7,675.46
|
| 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 |
$6,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,779.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.48
|
| Rate for Payer: PHCS Commercial |
$7,480.32
|
| Rate for Payer: United Healthcare All Payer |
$6,856.96
|
|
|
BRONCH RIGIDFLX PLCMNT TRACHST
|
Facility
|
IP
|
$7,792.00
|
|
|
Service Code
|
HCPCS 31631
|
| Hospital Charge Code |
761T1170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,337.60 |
| 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 |
$6,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,779.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.48
|
| Rate for Payer: PHCS Commercial |
$7,480.32
|
| Rate for Payer: United Healthcare All Payer |
$6,856.96
|
|
|
BRONCH THERMOPLSTY 1 LOBE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 31660
|
| Hospital Charge Code |
41000059
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BRONCH THERMOPLSTY 1 LOBE
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 31660
|
| Hospital Charge Code |
41000059
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Ambetter Exchange |
$175.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.79
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$396.00
|
| Rate for Payer: Healthspan PPO |
$224.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.66
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.36
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.66
|
|
|
BRONCH THERMOPLSTY 1 LOBE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 31660
|
| Hospital Charge Code |
41000059
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| 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 |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
