|
EBU GUIDE CATH 5F 3.5
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 3.75
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EBU GUIDE CATH 5F 3.75
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EBU GUIDE CATH 5F 4.0
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 4.0
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 4.5
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 4.5
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 5.0
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 5F 5.0
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EB VCA IGG
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EB VCA IGG
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Humana KY Medicaid |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EB VCA IGM
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Humana KY Medicaid |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EB VCA IGM
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.26
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0403
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$32.29 |
| Rate for Payer: Aetna Commercial |
$32.29
|
| Rate for Payer: Ambetter Exchange |
$13.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.24
|
| Rate for Payer: Multiplan PHCS |
$18.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.21
|
| Rate for Payer: UHCCP Medicaid |
$10.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.24
|
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS G0403
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.18
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Humana KY Medicaid |
$10.66
|
| Rate for Payer: Kentucky WC Medicaid |
$10.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
ECG FOR INITIAL PREV. PHYSICAL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS G0403
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.18
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 93224
|
| Hospital Charge Code |
48000072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 93224
|
| Hospital Charge Code |
48000072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
ECG RECORD/REVIEW
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 93268
|
| Hospital Charge Code |
48000075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$421.10
|
| Rate for Payer: Ambetter Exchange |
$150.47
|
| Rate for Payer: Anthem Medicaid |
$126.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.56
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$449.45
|
| Rate for Payer: Healthspan PPO |
$395.82
|
| Rate for Payer: Humana Medicaid |
$126.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$150.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.26
|
| Rate for Payer: Molina Healthcare Passport |
$126.73
|
| Rate for Payer: Multiplan PHCS |
$247.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.61
|
| Rate for Payer: UHCCP Medicaid |
$144.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.47
|
|
|
ECG RECORD/REVIEW
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 93268
|
| Hospital Charge Code |
48000075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$317.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$341.96
|
| Rate for Payer: First Health Commercial |
$391.40
|
| Rate for Payer: Humana Commercial |
$350.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
| Rate for Payer: Ohio Health Group HMO |
$309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$358.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.28
|
| Rate for Payer: PHCS Commercial |
$395.52
|
| Rate for Payer: United Healthcare All Payer |
$362.56
|
|
|
ECG RECORD/REVIEW
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 93268
|
| Hospital Charge Code |
48000075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$317.24
|
| Rate for Payer: Anthem Medicaid |
$141.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$341.96
|
| Rate for Payer: First Health Commercial |
$391.40
|
| Rate for Payer: Humana Commercial |
$350.20
|
| Rate for Payer: Humana KY Medicaid |
$141.69
|
| Rate for Payer: Kentucky WC Medicaid |
$143.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
| Rate for Payer: Ohio Health Group HMO |
$309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$358.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.28
|
| Rate for Payer: PHCS Commercial |
$395.52
|
| Rate for Payer: United Healthcare All Payer |
$362.56
|
|
|
ECG UP TO 48 HR HOLTER MONITOR
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
73000006
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$1,146.24 |
| Rate for Payer: Aetna Commercial |
$919.38
|
| Rate for Payer: Anthem Medicaid |
$410.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$931.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$991.02
|
| Rate for Payer: First Health Commercial |
$1,134.30
|
| Rate for Payer: Humana Commercial |
$1,014.90
|
| Rate for Payer: Humana KY Medicaid |
$410.62
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$414.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.72
|
| Rate for Payer: Ohio Health Group HMO |
$895.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.86
|
| Rate for Payer: PHCS Commercial |
$1,146.24
|
| Rate for Payer: United Healthcare All Payer |
$1,050.72
|
|
|
ECG UP TO 48 HR HOLTER MONITOR
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
73000006
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,146.24 |
| Rate for Payer: Aetna Commercial |
$919.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$931.32
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$991.02
|
| Rate for Payer: First Health Commercial |
$1,134.30
|
| Rate for Payer: Humana Commercial |
$1,014.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.72
|
| Rate for Payer: Ohio Health Group HMO |
$895.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.86
|
| Rate for Payer: PHCS Commercial |
$1,146.24
|
| Rate for Payer: United Healthcare All Payer |
$1,050.72
|
|
|
ECG W/12 LEADS - TRACING ONLY
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$20.68
|
| Rate for Payer: Ambetter Exchange |
$5.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.77
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.64
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.64
|
|
|
ECG W/12 LEADS - TRACING ONLY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
