|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0005
|
|
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 |
483T0005
|
|
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
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
IP
|
$3,318.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$431.34 |
| Max. Negotiated Rate |
$3,185.28 |
| Rate for Payer: Aetna Commercial |
$2,554.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,588.04
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$2,753.94
|
| Rate for Payer: First Health Commercial |
$3,152.10
|
| Rate for Payer: Humana Commercial |
$2,820.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,720.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,448.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,919.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,488.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.58
|
| Rate for Payer: PHCS Commercial |
$3,185.28
|
| Rate for Payer: United Healthcare All Payer |
$2,919.84
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Professional
|
Both
|
$3,318.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$3,318.00 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,318.00
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cash Price |
$1,659.00
|
| 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 |
$1,990.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,322.60
|
| Rate for Payer: UHCCP Medicaid |
$1,161.30
|
| 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 COMPLETE W/WO CONTRAST
|
Facility
|
IP
|
$3,068.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483T0011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$398.84 |
| Max. Negotiated Rate |
$2,945.28 |
| Rate for Payer: Aetna Commercial |
$2,362.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.04
|
| Rate for Payer: Cash Price |
$1,534.00
|
| Rate for Payer: Cigna Commercial |
$2,546.44
|
| Rate for Payer: First Health Commercial |
$2,914.60
|
| Rate for Payer: Humana Commercial |
$2,607.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,515.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,699.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$951.08
|
| Rate for Payer: PHCS Commercial |
$2,945.28
|
| Rate for Payer: United Healthcare All Payer |
$2,699.84
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
OP
|
$3,318.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$431.34 |
| Max. Negotiated Rate |
$3,185.28 |
| Rate for Payer: Aetna Commercial |
$2,554.86
|
| Rate for Payer: Anthem Medicaid |
$1,141.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,588.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$2,753.94
|
| Rate for Payer: First Health Commercial |
$3,152.10
|
| Rate for Payer: Humana Commercial |
$2,820.30
|
| Rate for Payer: Humana KY Medicaid |
$1,141.06
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,152.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,720.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,448.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,919.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,488.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.58
|
| Rate for Payer: PHCS Commercial |
$3,185.28
|
| Rate for Payer: United Healthcare All Payer |
$2,919.84
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
OP
|
$3,068.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483T0011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$398.84 |
| Max. Negotiated Rate |
$2,945.28 |
| Rate for Payer: Aetna Commercial |
$2,362.36
|
| Rate for Payer: Anthem Medicaid |
$1,055.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,534.00
|
| Rate for Payer: Cash Price |
$1,534.00
|
| Rate for Payer: Cigna Commercial |
$2,546.44
|
| Rate for Payer: First Health Commercial |
$2,914.60
|
| Rate for Payer: Humana Commercial |
$2,607.80
|
| Rate for Payer: Humana KY Medicaid |
$1,055.09
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,065.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,515.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,699.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$951.08
|
| Rate for Payer: PHCS Commercial |
$2,945.28
|
| Rate for Payer: United Healthcare All Payer |
$2,699.84
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0011
|
|
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 CONGENITAL
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$297.83 |
| Max. Negotiated Rate |
$2,199.36 |
| Rate for Payer: Aetna Commercial |
$1,764.07
|
| Rate for Payer: Anthem Medicaid |
$787.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,786.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cigna Commercial |
$1,901.53
|
| Rate for Payer: First Health Commercial |
$2,176.45
|
| Rate for Payer: Humana Commercial |
$1,947.35
|
| Rate for Payer: Humana KY Medicaid |
$787.87
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$795.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,878.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,690.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$803.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,016.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,718.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.21
|
| Rate for Payer: PHCS Commercial |
$2,199.36
|
| Rate for Payer: United Healthcare All Payer |
$2,016.08
|
|
|
ECHO CONGENITAL
|
Facility
|
OP
|
$1,394.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$181.22 |
| Max. Negotiated Rate |
$1,338.24 |
| Rate for Payer: Aetna Commercial |
$1,073.38
|
| Rate for Payer: Anthem Medicaid |
$479.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cigna Commercial |
$1,157.02
|
| Rate for Payer: First Health Commercial |
$1,324.30
|
| Rate for Payer: Humana Commercial |
$1,184.90
|
| Rate for Payer: Humana KY Medicaid |
$479.40
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$484.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$489.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.14
|
| Rate for Payer: PHCS Commercial |
$1,338.24
|
| Rate for Payer: United Healthcare All Payer |
$1,226.72
|
|
|
ECHO CONGENITAL
|
Professional
|
Both
|
$2,291.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$2,291.00 |
| Rate for Payer: Aetna Commercial |
$350.74
|
| Rate for Payer: Anthem Medicaid |
$166.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,291.00
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cigna Commercial |
$341.80
|
| Rate for Payer: Healthspan PPO |
$329.70
|
| Rate for Payer: Humana Medicaid |
$166.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.21
|
| Rate for Payer: Molina Healthcare Passport |
$166.87
|
| Rate for Payer: Multiplan PHCS |
$1,374.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,603.70
|
| Rate for Payer: UHCCP Medicaid |
$801.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.54
|
|
|
ECHO CONGENITAL
|
Facility
|
IP
|
$1,394.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$181.22 |
| Max. Negotiated Rate |
$1,338.24 |
| Rate for Payer: Aetna Commercial |
$1,073.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.32
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cigna Commercial |
$1,157.02
|
| Rate for Payer: First Health Commercial |
$1,324.30
|
| Rate for Payer: Humana Commercial |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.14
|
| Rate for Payer: PHCS Commercial |
$1,338.24
|
| Rate for Payer: United Healthcare All Payer |
$1,226.72
|
|
|
ECHO CONGENITAL
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$297.83 |
| Max. Negotiated Rate |
$2,199.36 |
| Rate for Payer: Aetna Commercial |
$1,764.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,786.98
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cigna Commercial |
$1,901.53
|
| Rate for Payer: First Health Commercial |
$2,176.45
|
| Rate for Payer: Humana Commercial |
$1,947.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,878.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,690.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,016.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,718.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.21
|
| Rate for Payer: PHCS Commercial |
$2,199.36
|
| Rate for Payer: United Healthcare All Payer |
$2,016.08
|
|
|
ECHO CONGENITAL LIMITED
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem Medicaid |
$489.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Humana KY Medicaid |
$489.71
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
ECHO CONGENITAL LIMITED
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
ECHO CONGENITAL LIMITED
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$216.27
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,424.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$191.70
|
| Rate for Payer: Healthspan PPO |
$203.30
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$854.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$996.80
|
| Rate for Payer: UHCCP Medicaid |
$498.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
ECHO CONGENITAL LIMITED (P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480P0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$216.27
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$191.70
|
| Rate for Payer: Healthspan PPO |
$203.30
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
ECHO CONGENITAL LIMITED (T
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480T0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$1,141.44 |
| Rate for Payer: Aetna Commercial |
$915.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$927.42
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$986.87
|
| Rate for Payer: First Health Commercial |
$1,129.55
|
| Rate for Payer: Humana Commercial |
$1,010.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,046.32
|
| Rate for Payer: Ohio Health Group HMO |
$891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.59
|
| Rate for Payer: PHCS Commercial |
$1,141.44
|
| Rate for Payer: United Healthcare All Payer |
$1,046.32
|
|
|
ECHO CONGENITAL LIMITED (T
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480T0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$1,141.44 |
| Rate for Payer: Aetna Commercial |
$915.53
|
| Rate for Payer: Anthem Medicaid |
$408.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$927.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$986.87
|
| Rate for Payer: First Health Commercial |
$1,129.55
|
| Rate for Payer: Humana Commercial |
$1,010.65
|
| Rate for Payer: Humana KY Medicaid |
$408.90
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$413.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,046.32
|
| Rate for Payer: Ohio Health Group HMO |
$891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.59
|
| Rate for Payer: PHCS Commercial |
$1,141.44
|
| Rate for Payer: United Healthcare All Payer |
$1,046.32
|
|
|
ECHO CONGENITAL LTD/FOLLOWUP
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$129.87 |
| Max. Negotiated Rate |
$959.04 |
| Rate for Payer: Aetna Commercial |
$769.23
|
| Rate for Payer: Anthem Medicaid |
$343.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$779.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna Commercial |
$829.17
|
| Rate for Payer: First Health Commercial |
$949.05
|
| Rate for Payer: Humana Commercial |
$849.15
|
| Rate for Payer: Humana KY Medicaid |
$343.56
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$347.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$819.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$737.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$879.12
|
| Rate for Payer: Ohio Health Group HMO |
$749.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$199.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.69
|
| Rate for Payer: PHCS Commercial |
$959.04
|
| Rate for Payer: United Healthcare All Payer |
$879.12
|
|
|
ECHO CONGENITAL LTD/FOLLOWUP
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$129.87 |
| Max. Negotiated Rate |
$959.04 |
| Rate for Payer: Aetna Commercial |
$769.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$779.22
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna Commercial |
$829.17
|
| Rate for Payer: First Health Commercial |
$949.05
|
| Rate for Payer: Humana Commercial |
$849.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$819.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$737.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$879.12
|
| Rate for Payer: Ohio Health Group HMO |
$749.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$199.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.69
|
| Rate for Payer: PHCS Commercial |
$959.04
|
| Rate for Payer: United Healthcare All Payer |
$879.12
|
|
|
ECHO CONGENITAL (P
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480P0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$350.74 |
| Rate for Payer: Aetna Commercial |
$350.74
|
| Rate for Payer: Anthem Medicaid |
$166.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$264.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$341.80
|
| Rate for Payer: Healthspan PPO |
$329.70
|
| Rate for Payer: Humana Medicaid |
$166.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.21
|
| Rate for Payer: Molina Healthcare Passport |
$166.87
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.80
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.54
|
|
|
ECHO CONGENITAL (T
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480T0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$263.51 |
| Max. Negotiated Rate |
$1,945.92 |
| Rate for Payer: Aetna Commercial |
$1,560.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,581.06
|
| Rate for Payer: Cash Price |
$1,013.50
|
| Rate for Payer: Cigna Commercial |
$1,682.41
|
| Rate for Payer: First Health Commercial |
$1,925.65
|
| Rate for Payer: Humana Commercial |
$1,722.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,662.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.37
|
| Rate for Payer: PHCS Commercial |
$1,945.92
|
| Rate for Payer: United Healthcare All Payer |
$1,783.76
|
|
|
ECHO CONGENITAL (T
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480T0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$263.51 |
| Max. Negotiated Rate |
$1,945.92 |
| Rate for Payer: Aetna Commercial |
$1,560.79
|
| Rate for Payer: Anthem Medicaid |
$697.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,581.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,013.50
|
| Rate for Payer: Cash Price |
$1,013.50
|
| Rate for Payer: Cigna Commercial |
$1,682.41
|
| Rate for Payer: First Health Commercial |
$1,925.65
|
| Rate for Payer: Humana Commercial |
$1,722.95
|
| Rate for Payer: Humana KY Medicaid |
$697.09
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$704.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,662.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.37
|
| Rate for Payer: PHCS Commercial |
$1,945.92
|
| Rate for Payer: United Healthcare All Payer |
$1,783.76
|
|
|
ECHO DOPPLER LIMITED
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
480T0109
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
