|
ECHELON THN SHFT REAMER 22.5MM
|
Facility
|
OP
|
$4,463.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$4,285.42 |
| Rate for Payer: Aetna Commercial |
$3,437.26
|
| Rate for Payer: Anthem Medicaid |
$1,535.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.90
|
| Rate for Payer: Cash Price |
$2,231.99
|
| Rate for Payer: Cigna Commercial |
$3,705.10
|
| Rate for Payer: First Health Commercial |
$4,240.78
|
| Rate for Payer: Humana Commercial |
$3,794.38
|
| Rate for Payer: Humana KY Medicaid |
$1,535.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,660.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,294.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,928.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.83
|
| Rate for Payer: PHCS Commercial |
$4,285.42
|
| Rate for Payer: United Healthcare All Payer |
$3,928.30
|
|
|
ECHO 2D W/COL/DOP W W/WO CON(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
|
|
ECHO 2D W/COL/DOP W W/WO CON(T
|
Facility
|
OP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$328.77 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem Medicaid |
$869.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Humana KY Medicaid |
$869.72
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$878.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.99
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CON(T
|
Facility
|
IP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$328.77 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.99
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$833.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$2,779.00 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,779.00
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$1,667.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,945.30
|
| Rate for Payer: UHCCP Medicaid |
$972.65
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem Medicaid |
$955.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Humana KY Medicaid |
$955.70
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$965.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$974.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$833.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$2,779.00 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,779.00
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$1,667.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,945.30
|
| Rate for Payer: UHCCP Medicaid |
$972.65
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem Medicaid |
$955.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Humana KY Medicaid |
$955.70
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$965.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$974.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(T
|
Facility
|
IP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$328.77 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.99
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(T
|
Facility
|
OP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$328.77 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem Medicaid |
$869.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Humana KY Medicaid |
$869.72
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$878.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.99
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483P0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$302.43 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483P0005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Professional
|
Both
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$1,895.00 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,895.00
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$1,137.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,326.50
|
| Rate for Payer: UHCCP Medicaid |
$663.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300004
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.20
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300004
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,620.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,134.00
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem Medicaid |
$557.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Humana KY Medicaid |
$557.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$568.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.20
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$1,819.20 |
| Rate for Payer: Aetna Commercial |
$1,459.15
|
| Rate for Payer: Anthem Medicaid |
$651.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$1,572.85
|
| Rate for Payer: First Health Commercial |
$1,800.25
|
| Rate for Payer: Humana Commercial |
$1,610.75
|
| Rate for Payer: Humana KY Medicaid |
$651.69
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$658.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.45
|
| Rate for Payer: PHCS Commercial |
$1,819.20
|
| Rate for Payer: United Healthcare All Payer |
$1,667.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$246.35 |
| Max. Negotiated Rate |
$1,819.20 |
| Rate for Payer: Aetna Commercial |
$1,459.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.10
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$1,572.85
|
| Rate for Payer: First Health Commercial |
$1,800.25
|
| Rate for Payer: Humana Commercial |
$1,610.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.45
|
| Rate for Payer: PHCS Commercial |
$1,819.20
|
| Rate for Payer: United Healthcare All Payer |
$1,667.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.45
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.45
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
