|
EKG REGULAR
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$98.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$98.01
|
| Rate for Payer: Kentucky WC Medicaid |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
EKG REGULAR(P INTERP REPORT
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
730P0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Anthem Medicaid |
$9.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$13.30
|
| Rate for Payer: Healthspan PPO |
$14.09
|
| Rate for Payer: Humana Medicaid |
$9.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Molina Healthcare Passport |
$9.52
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.62
|
|
|
EKG REGULAR(T
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EKG REGULAR(T
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem Medicaid |
$6.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Humana KY Medicaid |
$6.53
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$6.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Anthem Medicaid |
$12.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$19.00
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$24.77
|
| Rate for Payer: Healthspan PPO |
$17.78
|
| Rate for Payer: Humana Medicaid |
$12.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.51
|
| Rate for Payer: Molina Healthcare Passport |
$12.26
|
| Rate for Payer: Multiplan PHCS |
$11.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.30
|
| Rate for Payer: UHCCP Medicaid |
$6.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.38
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.89
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EKOS + KIT 106CM*12CM
|
Facility
|
OP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem Medicaid |
$5,647.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Humana KY Medicaid |
$5,647.53
|
| Rate for Payer: Kentucky WC Medicaid |
$5,705.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,760.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
EKOS + KIT 106CM*12CM
|
Facility
|
IP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
EKO SONIC 40CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC 40CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC 50CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC 50CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 12CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 12CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 18CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 18CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 24CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
|
|
EKO SONIC MACH 4 24CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 30CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 30CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 6CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
EKO SONIC MACH 4 6CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
ELATION PUL BALL DIL 2CM 10-11
|
Facility
|
IP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
ELATION PUL BALL DIL 2CM 10-11
|
Facility
|
OP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem Medicaid |
$1,087.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Humana KY Medicaid |
$1,087.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
