|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
DX BRONCHOSCOPE/BRUSH(P
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
410P0035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$417.03 |
| Rate for Payer: Aetna Commercial |
$243.94
|
| Rate for Payer: Ambetter Exchange |
$122.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$181.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.37
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$222.18
|
| Rate for Payer: Healthspan PPO |
$417.03
|
| Rate for Payer: Humana Medicaid |
$181.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.79
|
| Rate for Payer: Molina Healthcare Passport |
$181.17
|
| Rate for Payer: Multiplan PHCS |
$222.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.65
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.81
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$118.65 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| 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 |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$388.60 |
| Rate for Payer: Aetna Commercial |
$244.51
|
| Rate for Payer: Ambetter Exchange |
$124.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.66
|
| Rate for Payer: Anthem Medicaid |
$182.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.54
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$222.18
|
| Rate for Payer: Healthspan PPO |
$388.60
|
| Rate for Payer: Humana Medicaid |
$182.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.50
|
| Rate for Payer: Molina Healthcare Passport |
$182.84
|
| Rate for Payer: Multiplan PHCS |
$207.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.01
|
| Rate for Payer: UHCCP Medicaid |
$71.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.62
|
|
|
DX BRONCHOSCOPE/LAVAGE(P
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
410P0036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$388.60 |
| Rate for Payer: Aetna Commercial |
$244.51
|
| Rate for Payer: Ambetter Exchange |
$124.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.66
|
| Rate for Payer: Anthem Medicaid |
$182.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.54
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$222.18
|
| Rate for Payer: Healthspan PPO |
$388.60
|
| Rate for Payer: Humana Medicaid |
$182.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.50
|
| Rate for Payer: Molina Healthcare Passport |
$182.84
|
| Rate for Payer: Multiplan PHCS |
$207.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.01
|
| Rate for Payer: UHCCP Medicaid |
$71.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.62
|
|
|
DX FIBERTAK SUTURE ANCHOR #2
|
Facility
|
IP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
DX FIBERTAK SUTURE ANCHOR #2
|
Facility
|
OP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem Medicaid |
$5,487.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Humana KY Medicaid |
$5,487.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,543.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,598.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
DX LARYNGOSCOPY W/OPER SCOPE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
41000019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$148.32 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$238.78
|
| Rate for Payer: Ambetter Exchange |
$148.32
|
| Rate for Payer: Anthem Medicaid |
$172.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.98
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$240.97
|
| Rate for Payer: Healthspan PPO |
$201.37
|
| Rate for Payer: Humana Medicaid |
$172.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.35
|
| Rate for Payer: Molina Healthcare Passport |
$172.89
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.82
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.32
|
|
|
DX LARYNGOSCOPY W/OPER SCOPE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
41000019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
DX LARYNGOSCOPY W/OPER SCOPE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
41000019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
DX LARYNGOSCOPY W/OPER SCOP(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
410P0019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$148.32 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$238.78
|
| Rate for Payer: Ambetter Exchange |
$148.32
|
| Rate for Payer: Anthem Medicaid |
$172.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.98
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$240.97
|
| Rate for Payer: Healthspan PPO |
$201.37
|
| Rate for Payer: Humana Medicaid |
$172.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.35
|
| Rate for Payer: Molina Healthcare Passport |
$172.89
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.82
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.32
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
36001289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Ambetter Exchange |
$80.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.18
|
| Rate for Payer: Anthem Medicaid |
$197.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.19
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Humana Medicaid |
$197.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.23
|
| Rate for Payer: Molina Healthcare Passport |
$197.28
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.21
|
| Rate for Payer: UHCCP Medicaid |
$76.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.16
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
76102742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.99 |
| Max. Negotiated Rate |
$1,150.08 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem Medicaid |
$411.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Humana KY Medicaid |
$411.99
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$416.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
36001289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Professional
|
Both
|
$1,198.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
76102742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$718.80 |
| Rate for Payer: Ambetter Exchange |
$80.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.18
|
| Rate for Payer: Anthem Medicaid |
$197.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.19
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Humana Medicaid |
$197.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.23
|
| Rate for Payer: Molina Healthcare Passport |
$197.28
|
| Rate for Payer: Multiplan PHCS |
$718.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.21
|
| Rate for Payer: UHCCP Medicaid |
$76.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.16
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
76102742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.40 |
| Max. Negotiated Rate |
$1,150.08 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
36001289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.28 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
761P2742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$201.23 |
| Rate for Payer: Ambetter Exchange |
$80.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.18
|
| Rate for Payer: Anthem Medicaid |
$197.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.19
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Humana Medicaid |
$197.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.23
|
| Rate for Payer: Molina Healthcare Passport |
$197.28
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.21
|
| Rate for Payer: UHCCP Medicaid |
$76.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.16
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
360P1289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$201.23 |
| Rate for Payer: Ambetter Exchange |
$80.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.18
|
| Rate for Payer: Anthem Medicaid |
$197.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.19
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Humana Medicaid |
$197.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.23
|
| Rate for Payer: Molina Healthcare Passport |
$197.28
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.21
|
| Rate for Payer: UHCCP Medicaid |
$76.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.16
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (T
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
360T1289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (T
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
761T2742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.02 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem Medicaid |
$326.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Humana KY Medicaid |
$326.02
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$329.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (T
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
360T1289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
DX LMBR SPI PNXR W/FLUOR/CT (T
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
761T2742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.40 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
DX SWIVELOCK 3.5X8.5MM W/FORKT
|
Facility
|
OP
|
$3,593.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem Medicaid |
$1,235.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Humana KY Medicaid |
$1,235.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
