EBU GUIDE CATH 5F 3.0
|
Facility
|
IP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 3.0
|
Facility
|
OP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem Medicaid |
$266.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Humana KY Medicaid |
$266.69
|
Rate for Payer: Kentucky WC Medicaid |
$269.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 3.5
|
Facility
|
OP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem Medicaid |
$266.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Humana KY Medicaid |
$266.69
|
Rate for Payer: Kentucky WC Medicaid |
$269.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 3.5
|
Facility
|
IP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 3.75
|
Facility
|
IP
|
$784.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$101.98 |
Max. Negotiated Rate |
$753.12 |
Rate for Payer: Aetna Commercial |
$604.06
|
Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
Rate for Payer: Cash Price |
$392.25
|
Rate for Payer: Cigna Commercial |
$651.14
|
Rate for Payer: First Health Commercial |
$745.28
|
Rate for Payer: Humana Commercial |
$666.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
Rate for Payer: Ohio Health Group HMO |
$588.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
Rate for Payer: PHCS Commercial |
$753.12
|
Rate for Payer: United Healthcare All Payer |
$690.36
|
|
EBU GUIDE CATH 5F 3.75
|
Facility
|
OP
|
$784.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$101.98 |
Max. Negotiated Rate |
$753.12 |
Rate for Payer: Aetna Commercial |
$604.06
|
Rate for Payer: Anthem Medicaid |
$269.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
Rate for Payer: Cash Price |
$392.25
|
Rate for Payer: Cigna Commercial |
$651.14
|
Rate for Payer: First Health Commercial |
$745.28
|
Rate for Payer: Humana Commercial |
$666.82
|
Rate for Payer: Humana KY Medicaid |
$269.79
|
Rate for Payer: Kentucky WC Medicaid |
$272.54
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
Rate for Payer: Ohio Health Group HMO |
$588.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
Rate for Payer: PHCS Commercial |
$753.12
|
Rate for Payer: United Healthcare All Payer |
$690.36
|
|
EBU GUIDE CATH 5F 4.0
|
Facility
|
OP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem Medicaid |
$266.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Humana KY Medicaid |
$266.69
|
Rate for Payer: Kentucky WC Medicaid |
$269.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 4.0
|
Facility
|
IP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 4.5
|
Facility
|
IP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 4.5
|
Facility
|
OP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem Medicaid |
$266.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Humana KY Medicaid |
$266.69
|
Rate for Payer: Kentucky WC Medicaid |
$269.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 5.0
|
Facility
|
IP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EBU GUIDE CATH 5F 5.0
|
Facility
|
OP
|
$775.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.82 |
Max. Negotiated Rate |
$744.48 |
Rate for Payer: Aetna Commercial |
$597.14
|
Rate for Payer: Anthem Medicaid |
$266.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
Rate for Payer: Cash Price |
$387.75
|
Rate for Payer: Cigna Commercial |
$643.66
|
Rate for Payer: First Health Commercial |
$736.72
|
Rate for Payer: Humana Commercial |
$659.18
|
Rate for Payer: Humana KY Medicaid |
$266.69
|
Rate for Payer: Kentucky WC Medicaid |
$269.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
Rate for Payer: Ohio Health Group HMO |
$581.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
Rate for Payer: PHCS Commercial |
$744.48
|
Rate for Payer: United Healthcare All Payer |
$682.44
|
|
EB VCA IGG
|
Facility
|
OP
|
$19.00
|
|
Service Code
|
HCPCS 86665
|
Hospital Charge Code |
30001156
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$2.47 |
Max. Negotiated Rate |
$25.40 |
Rate for Payer: Aetna Commercial |
$14.63
|
Rate for Payer: Anthem Medicaid |
$18.14
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cigna Commercial |
$15.77
|
Rate for Payer: First Health Commercial |
$18.05
|
Rate for Payer: Humana Commercial |
$16.15
|
Rate for Payer: Humana KY Medicaid |
$18.14
|
Rate for Payer: Humana Medicare Advantage |
$18.14
|
Rate for Payer: Kentucky WC Medicaid |
$18.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
Rate for Payer: Ohio Health Group HMO |
$14.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
Rate for Payer: PHCS Commercial |
$18.24
|
Rate for Payer: United Healthcare All Payer |
$16.72
|
|
EB VCA IGG
|
Facility
|
IP
|
$19.00
|
|
Service Code
|
HCPCS 86665
|
Hospital Charge Code |
30001156
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$2.47 |
Max. Negotiated Rate |
$18.24 |
Rate for Payer: Aetna Commercial |
$14.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cigna Commercial |
$15.77
|
Rate for Payer: First Health Commercial |
$18.05
|
Rate for Payer: Humana Commercial |
$16.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
Rate for Payer: Ohio Health Group HMO |
$14.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
Rate for Payer: PHCS Commercial |
$18.24
|
Rate for Payer: United Healthcare All Payer |
$16.72
|
|
EB VCA IGM
|
Facility
|
IP
|
$19.00
|
|
Service Code
|
HCPCS 86665
|
Hospital Charge Code |
30001154
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$2.47 |
Max. Negotiated Rate |
$18.24 |
Rate for Payer: Aetna Commercial |
$14.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cigna Commercial |
$15.77
|
Rate for Payer: First Health Commercial |
$18.05
|
Rate for Payer: Humana Commercial |
$16.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
Rate for Payer: Ohio Health Group HMO |
$14.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
Rate for Payer: PHCS Commercial |
$18.24
|
Rate for Payer: United Healthcare All Payer |
$16.72
|
|
EB VCA IGM
|
Facility
|
OP
|
$19.00
|
|
Service Code
|
HCPCS 86665
|
Hospital Charge Code |
30001154
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$2.47 |
Max. Negotiated Rate |
$25.40 |
Rate for Payer: Aetna Commercial |
$14.63
|
Rate for Payer: Anthem Medicaid |
$18.14
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cash Price |
$9.50
|
Rate for Payer: Cigna Commercial |
$15.77
|
Rate for Payer: First Health Commercial |
$18.05
|
Rate for Payer: Humana Commercial |
$16.15
|
Rate for Payer: Humana KY Medicaid |
$18.14
|
Rate for Payer: Humana Medicare Advantage |
$18.14
|
Rate for Payer: Kentucky WC Medicaid |
$18.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
Rate for Payer: Ohio Health Group HMO |
$14.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
Rate for Payer: PHCS Commercial |
$18.24
|
Rate for Payer: United Healthcare All Payer |
$16.72
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Facility
|
OP
|
$31.00
|
|
Service Code
|
HCPCS G0403
|
Hospital Charge Code |
73000004
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$4.03 |
Max. Negotiated Rate |
$29.76 |
Rate for Payer: Aetna Commercial |
$23.87
|
Rate for Payer: Anthem Medicaid |
$10.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$24.18
|
Rate for Payer: Cash Price |
$15.50
|
Rate for Payer: Cigna Commercial |
$25.73
|
Rate for Payer: First Health Commercial |
$29.45
|
Rate for Payer: Humana Commercial |
$26.35
|
Rate for Payer: Humana KY Medicaid |
$10.66
|
Rate for Payer: Kentucky WC Medicaid |
$10.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
Rate for Payer: Molina Healthcare Medicaid |
$10.87
|
Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
Rate for Payer: Ohio Health Group HMO |
$23.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.61
|
Rate for Payer: PHCS Commercial |
$29.76
|
Rate for Payer: United Healthcare All Payer |
$27.28
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Facility
|
IP
|
$31.00
|
|
Service Code
|
HCPCS G0403
|
Hospital Charge Code |
73000004
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$4.03 |
Max. Negotiated Rate |
$29.76 |
Rate for Payer: Aetna Commercial |
$23.87
|
Rate for Payer: Anthem POS/PPO/Traditional |
$24.18
|
Rate for Payer: Cash Price |
$15.50
|
Rate for Payer: Cigna Commercial |
$25.73
|
Rate for Payer: First Health Commercial |
$29.45
|
Rate for Payer: Humana Commercial |
$26.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
Rate for Payer: Ohio Health Group HMO |
$23.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.61
|
Rate for Payer: PHCS Commercial |
$29.76
|
Rate for Payer: United Healthcare All Payer |
$27.28
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Professional
|
Both
|
$31.00
|
|
Service Code
|
HCPCS G0403
|
Hospital Charge Code |
73000004
|
Hospital Revenue Code
|
730
|
Min. Negotiated Rate |
$10.85 |
Max. Negotiated Rate |
$32.29 |
Rate for Payer: Aetna Commercial |
$32.29
|
Rate for Payer: Buckeye Medicare Advantage |
$31.00
|
Rate for Payer: Cash Price |
$15.50
|
Rate for Payer: Cash Price |
$15.50
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.90
|
Rate for Payer: Multiplan PHCS |
$18.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.70
|
Rate for Payer: UHCCP Medicaid |
$10.85
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$300.00
|
|
Service Code
|
HCPCS 93224
|
Hospital Charge Code |
48000072
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$39.00 |
Max. Negotiated Rate |
$288.00 |
Rate for Payer: Aetna Commercial |
$231.00
|
Rate for Payer: Anthem Medicaid |
$103.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
Rate for Payer: Cash Price |
$150.00
|
Rate for Payer: Cigna Commercial |
$249.00
|
Rate for Payer: First Health Commercial |
$285.00
|
Rate for Payer: Humana Commercial |
$255.00
|
Rate for Payer: Humana KY Medicaid |
$103.17
|
Rate for Payer: Kentucky WC Medicaid |
$104.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
Rate for Payer: Ohio Health Group HMO |
$225.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
Rate for Payer: PHCS Commercial |
$288.00
|
Rate for Payer: United Healthcare All Payer |
$264.00
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$300.00
|
|
Service Code
|
HCPCS 93224
|
Hospital Charge Code |
48000072
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$39.00 |
Max. Negotiated Rate |
$288.00 |
Rate for Payer: Aetna Commercial |
$231.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
Rate for Payer: Cash Price |
$150.00
|
Rate for Payer: Cigna Commercial |
$249.00
|
Rate for Payer: First Health Commercial |
$285.00
|
Rate for Payer: Humana Commercial |
$255.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
Rate for Payer: Ohio Health Group HMO |
$225.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
Rate for Payer: PHCS Commercial |
$288.00
|
Rate for Payer: United Healthcare All Payer |
$264.00
|
|
ECG RECORD/REVIEW
|
Professional
|
Both
|
$412.00
|
|
Service Code
|
HCPCS 93268
|
Hospital Charge Code |
48000075
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$126.73 |
Max. Negotiated Rate |
$449.45 |
Rate for Payer: Aetna Commercial |
$421.10
|
Rate for Payer: Anthem Medicaid |
$126.73
|
Rate for Payer: Buckeye Medicare Advantage |
$412.00
|
Rate for Payer: Cash Price |
$206.00
|
Rate for Payer: Cash Price |
$206.00
|
Rate for Payer: Cigna Commercial |
$449.45
|
Rate for Payer: Healthspan PPO |
$395.82
|
Rate for Payer: Humana Medicaid |
$126.73
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.49
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.26
|
Rate for Payer: Molina Healthcare Passport |
$126.73
|
Rate for Payer: Multiplan PHCS |
$247.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$288.40
|
Rate for Payer: UHCCP Medicaid |
$144.20
|
Rate for Payer: Wellcare CHIP/Medicaid |
$128.00
|
|
ECG RECORD/REVIEW
|
Facility
|
OP
|
$412.00
|
|
Service Code
|
HCPCS 93268
|
Hospital Charge Code |
48000075
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$53.56 |
Max. Negotiated Rate |
$395.52 |
Rate for Payer: Aetna Commercial |
$317.24
|
Rate for Payer: Anthem Medicaid |
$141.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
Rate for Payer: Cash Price |
$206.00
|
Rate for Payer: Cigna Commercial |
$341.96
|
Rate for Payer: First Health Commercial |
$391.40
|
Rate for Payer: Humana Commercial |
$350.20
|
Rate for Payer: Humana KY Medicaid |
$141.69
|
Rate for Payer: Kentucky WC Medicaid |
$143.13
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$123.60
|
Rate for Payer: Molina Healthcare Medicaid |
$144.53
|
Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
Rate for Payer: Ohio Health Group HMO |
$309.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$53.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.72
|
Rate for Payer: PHCS Commercial |
$395.52
|
Rate for Payer: United Healthcare All Payer |
$362.56
|
|
ECG RECORD/REVIEW
|
Facility
|
IP
|
$412.00
|
|
Service Code
|
HCPCS 93268
|
Hospital Charge Code |
48000075
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$53.56 |
Max. Negotiated Rate |
$395.52 |
Rate for Payer: Aetna Commercial |
$317.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
Rate for Payer: Cash Price |
$206.00
|
Rate for Payer: Cigna Commercial |
$341.96
|
Rate for Payer: First Health Commercial |
$391.40
|
Rate for Payer: Humana Commercial |
$350.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$123.60
|
Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
Rate for Payer: Ohio Health Group HMO |
$309.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$53.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.72
|
Rate for Payer: PHCS Commercial |
$395.52
|
Rate for Payer: United Healthcare All Payer |
$362.56
|
|
ECG UP TO 48 HR HOLTER MONITOR
|
Facility
|
IP
|
$1,121.00
|
|
Service Code
|
HCPCS 93226
|
Hospital Charge Code |
73000006
|
Hospital Revenue Code
|
731
|
Min. Negotiated Rate |
$145.73 |
Max. Negotiated Rate |
$1,076.16 |
Rate for Payer: Aetna Commercial |
$863.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$874.38
|
Rate for Payer: Cash Price |
$560.50
|
Rate for Payer: Cigna Commercial |
$930.43
|
Rate for Payer: First Health Commercial |
$1,064.95
|
Rate for Payer: Humana Commercial |
$952.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$919.22
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.30
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$336.30
|
Rate for Payer: Ohio Health Choice Commercial |
$986.48
|
Rate for Payer: Ohio Health Group HMO |
$840.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$224.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$145.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.51
|
Rate for Payer: PHCS Commercial |
$1,076.16
|
Rate for Payer: United Healthcare All Payer |
$986.48
|
|