|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470T0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.46
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
OP
|
$264.26
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$203.48
|
| Rate for Payer: Anthem Medicaid |
$90.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cigna Commercial |
$219.34
|
| Rate for Payer: First Health Commercial |
$251.05
|
| Rate for Payer: Humana Commercial |
$224.62
|
| Rate for Payer: Humana KY Medicaid |
$90.88
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.55
|
| Rate for Payer: Ohio Health Group HMO |
$198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.92
|
| Rate for Payer: PHCS Commercial |
$253.69
|
| Rate for Payer: United Healthcare All Payer |
$232.55
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Professional
|
Both
|
$107.20
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470P0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$107.20 |
| Rate for Payer: Anthem Medicaid |
$94.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.20
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Humana Medicaid |
$94.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.26
|
| Rate for Payer: Molina Healthcare Passport |
$94.37
|
| Rate for Payer: Multiplan PHCS |
$64.32
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.04
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.31
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
OP
|
$268.20
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$206.51
|
| Rate for Payer: Anthem Medicaid |
$92.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$222.61
|
| Rate for Payer: First Health Commercial |
$254.79
|
| Rate for Payer: Humana Commercial |
$227.97
|
| Rate for Payer: Humana KY Medicaid |
$92.23
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$93.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.02
|
| Rate for Payer: Ohio Health Group HMO |
$201.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.14
|
| Rate for Payer: PHCS Commercial |
$257.47
|
| Rate for Payer: United Healthcare All Payer |
$236.02
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470T0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$55.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$55.37
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$55.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
IP
|
$268.20
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$257.47 |
| Rate for Payer: Aetna Commercial |
$206.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.20
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$222.61
|
| Rate for Payer: First Health Commercial |
$254.79
|
| Rate for Payer: Humana Commercial |
$227.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.02
|
| Rate for Payer: Ohio Health Group HMO |
$201.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.14
|
| Rate for Payer: PHCS Commercial |
$257.47
|
| Rate for Payer: United Healthcare All Payer |
$236.02
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470T0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Professional
|
Both
|
$268.20
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$93.87 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Anthem Medicaid |
$94.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$268.20
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Humana Medicaid |
$94.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.26
|
| Rate for Payer: Molina Healthcare Passport |
$94.37
|
| Rate for Payer: Multiplan PHCS |
$160.92
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.74
|
| Rate for Payer: UHCCP Medicaid |
$93.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.31
|
|
|
AEROBIC CULTURE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
AEROBIC CULTURE
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.00
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$4.94
|
| Rate for Payer: Multiplan PHCS |
$65.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.30
|
| Rate for Payer: UHCCP Medicaid |
$38.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.93
|
|
|
AEROBIC CULTURE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
AERO DV TRACHBRONCH STENT 12*2
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STENT 12*2
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STENT 12*3
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STENT 12*3
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STENT 14*3
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
AERO DV TRACHBRONCH STENT 14*3
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
AERO DV TRACHBRONCH STENT 18*4
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STENT 18*4
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STNT 14*20
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AERO DV TRACHBRONCH STNT 14*20
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
AEROMINI TRACHBRNCH STENT 8*15
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRACHBRNCH STENT 8*15
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRACHOBRONCH STENT 6*
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRACHOBRONCH STENT 6*
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
