|
ECHO DOPPLER LIMITED
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
ECHO DOPPLER LIMITED
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000109
|
|
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 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: 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: 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
|
|
|
ECHO DOPPLER LIMITED
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000109
|
|
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
|
|
|
ECHO DOPPLER LIMITED
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000109
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Aetna Commercial |
$56.85
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$543.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$73.18
|
| Rate for Payer: Healthspan PPO |
$53.44
|
| Rate for Payer: Humana Medicaid |
$40.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.41
|
| Rate for Payer: Molina Healthcare Passport |
$40.60
|
| Rate for Payer: Multiplan PHCS |
$325.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$380.10
|
| Rate for Payer: UHCCP Medicaid |
$190.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.01
|
|
|
ECHO GUIDE FOR ARTERY REPAI(P
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402P0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$500.11 |
| Rate for Payer: Aetna Commercial |
$306.08
|
| Rate for Payer: Anthem Medicaid |
$264.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$415.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$500.11
|
| Rate for Payer: Healthspan PPO |
$286.80
|
| Rate for Payer: Humana Medicaid |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Molina Healthcare Passport |
$264.25
|
| Rate for Payer: Multiplan PHCS |
$249.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.50
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.89
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Facility
|
OP
|
$1,631.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$212.03 |
| Max. Negotiated Rate |
$1,565.76 |
| Rate for Payer: Aetna Commercial |
$1,255.87
|
| Rate for Payer: Anthem Medicaid |
$560.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cigna Commercial |
$1,353.73
|
| Rate for Payer: First Health Commercial |
$1,549.45
|
| Rate for Payer: Humana Commercial |
$1,386.35
|
| Rate for Payer: Humana KY Medicaid |
$560.90
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$566.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,337.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,203.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$572.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,435.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,223.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.61
|
| Rate for Payer: PHCS Commercial |
$1,565.76
|
| Rate for Payer: United Healthcare All Payer |
$1,435.28
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Professional
|
Both
|
$1,631.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna Commercial |
$306.08
|
| Rate for Payer: Anthem Medicaid |
$264.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,631.00
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cigna Commercial |
$500.11
|
| Rate for Payer: Healthspan PPO |
$286.80
|
| Rate for Payer: Humana Medicaid |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Molina Healthcare Passport |
$264.25
|
| Rate for Payer: Multiplan PHCS |
$978.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,141.70
|
| Rate for Payer: UHCCP Medicaid |
$570.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.89
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Facility
|
IP
|
$1,631.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$212.03 |
| Max. Negotiated Rate |
$1,565.76 |
| Rate for Payer: Aetna Commercial |
$1,255.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.18
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cigna Commercial |
$1,353.73
|
| Rate for Payer: First Health Commercial |
$1,549.45
|
| Rate for Payer: Humana Commercial |
$1,386.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,337.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,203.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,435.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,223.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.61
|
| Rate for Payer: PHCS Commercial |
$1,565.76
|
| Rate for Payer: United Healthcare All Payer |
$1,435.28
|
|
|
ECHO GUIDE FOR ARTERY REPAI(T
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402T0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$1,167.36 |
| Rate for Payer: Aetna Commercial |
$936.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$948.48
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$1,009.28
|
| Rate for Payer: First Health Commercial |
$1,155.20
|
| Rate for Payer: Humana Commercial |
$1,033.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$997.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$897.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,070.08
|
| Rate for Payer: Ohio Health Group HMO |
$912.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.96
|
| Rate for Payer: PHCS Commercial |
$1,167.36
|
| Rate for Payer: United Healthcare All Payer |
$1,070.08
|
|
|
ECHO GUIDE FOR ARTERY REPAI(T
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402T0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$1,167.36 |
| Rate for Payer: Aetna Commercial |
$936.32
|
| Rate for Payer: Anthem Medicaid |
$418.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$948.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$1,009.28
|
| Rate for Payer: First Health Commercial |
$1,155.20
|
| Rate for Payer: Humana Commercial |
$1,033.60
|
| Rate for Payer: Humana KY Medicaid |
$418.18
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$422.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$997.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$897.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,070.08
|
| Rate for Payer: Ohio Health Group HMO |
$912.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.96
|
| Rate for Payer: PHCS Commercial |
$1,167.36
|
| Rate for Payer: United Healthcare All Payer |
$1,070.08
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Professional
|
Both
|
$3,356.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$3,356.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,356.00
|
| Rate for Payer: Cash Price |
$1,678.00
|
| Rate for Payer: Cash Price |
$1,678.00
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$2,013.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,349.20
|
| Rate for Payer: UHCCP Medicaid |
$1,174.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483T0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem Medicaid |
$1,124.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Humana KY Medicaid |
$1,124.90
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
IP
|
$3,356.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$436.28 |
| Max. Negotiated Rate |
$3,221.76 |
| Rate for Payer: Aetna Commercial |
$2,584.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,617.68
|
| Rate for Payer: Cash Price |
$1,678.00
|
| Rate for Payer: Cigna Commercial |
$2,785.48
|
| Rate for Payer: First Health Commercial |
$3,188.20
|
| Rate for Payer: Humana Commercial |
$2,852.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,476.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,953.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,517.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.36
|
| Rate for Payer: PHCS Commercial |
$3,221.76
|
| Rate for Payer: United Healthcare All Payer |
$2,953.28
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483T0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
OP
|
$3,356.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,221.76 |
| Rate for Payer: Aetna Commercial |
$2,584.12
|
| Rate for Payer: Anthem Medicaid |
$1,154.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,617.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,678.00
|
| Rate for Payer: Cash Price |
$1,678.00
|
| Rate for Payer: Cigna Commercial |
$2,785.48
|
| Rate for Payer: First Health Commercial |
$3,188.20
|
| Rate for Payer: Humana Commercial |
$2,852.60
|
| Rate for Payer: Humana KY Medicaid |
$1,154.13
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,165.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,476.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,177.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,953.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,517.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.36
|
| Rate for Payer: PHCS Commercial |
$3,221.76
|
| Rate for Payer: United Healthcare All Payer |
$2,953.28
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483P0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
|
|
ECHO LTD
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem Medicaid |
$387.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Humana KY Medicaid |
$387.58
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$391.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.37
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO LTD
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.37
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO LTD - FOLLOWUP
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$157.56 |
| Max. Negotiated Rate |
$1,163.52 |
| Rate for Payer: Aetna Commercial |
$933.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$945.36
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$1,005.96
|
| Rate for Payer: First Health Commercial |
$1,151.40
|
| Rate for Payer: Humana Commercial |
$1,030.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$993.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$894.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,066.56
|
| Rate for Payer: Ohio Health Group HMO |
$909.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$375.72
|
| Rate for Payer: PHCS Commercial |
$1,163.52
|
| Rate for Payer: United Healthcare All Payer |
$1,066.56
|
|
|
ECHO LTD - FOLLOWUP
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$157.56 |
| Max. Negotiated Rate |
$1,163.52 |
| Rate for Payer: Aetna Commercial |
$933.24
|
| Rate for Payer: Anthem Medicaid |
$416.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$945.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$1,005.96
|
| Rate for Payer: First Health Commercial |
$1,151.40
|
| Rate for Payer: Humana Commercial |
$1,030.20
|
| Rate for Payer: Humana KY Medicaid |
$416.81
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$421.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$993.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$894.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$425.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,066.56
|
| Rate for Payer: Ohio Health Group HMO |
$909.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$375.72
|
| Rate for Payer: PHCS Commercial |
$1,163.52
|
| Rate for Payer: United Healthcare All Payer |
$1,066.56
|
|
|
ECHO LTD - FOLLOWUP
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$1,212.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,212.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$727.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$848.40
|
| Rate for Payer: UHCCP Medicaid |
$424.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
|
|
ECHO LTD - FOLLOWUP(P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483P0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
|
|
ECHO LTD - FOLLOWUP(T
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483T0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.37
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO LTD - FOLLOWUP(T
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483T0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem Medicaid |
$387.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Humana KY Medicaid |
$387.58
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$391.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.37
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO MYOCARDIAL STRAIN
|
Facility
|
OP
|
$66.06
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
48000111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.42 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Anthem Medicaid |
$22.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.53
|
| Rate for Payer: Cash Price |
$33.03
|
| Rate for Payer: Cigna Commercial |
$54.83
|
| Rate for Payer: First Health Commercial |
$62.76
|
| Rate for Payer: Humana Commercial |
$56.15
|
| Rate for Payer: Humana KY Medicaid |
$22.72
|
| Rate for Payer: Kentucky WC Medicaid |
$22.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.13
|
| Rate for Payer: Ohio Health Group HMO |
$49.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.48
|
| Rate for Payer: PHCS Commercial |
$63.42
|
| Rate for Payer: United Healthcare All Payer |
$58.13
|
|
