|
ECHO 2D W/COL/DOP W W/WO CON(T
|
Facility
|
OP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem Medicaid |
$869.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Humana KY Medicaid |
$869.72
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$878.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.01
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CON(T
|
Facility
|
IP
|
$2,529.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$758.70 |
| Max. Negotiated Rate |
$2,427.84 |
| Rate for Payer: Aetna Commercial |
$1,947.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,972.62
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna Commercial |
$2,099.07
|
| Rate for Payer: First Health Commercial |
$2,402.55
|
| Rate for Payer: Humana Commercial |
$2,149.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,073.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,866.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,225.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.01
|
| Rate for Payer: PHCS Commercial |
$2,427.84
|
| Rate for Payer: United Healthcare All Payer |
$2,225.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$833.70 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$833.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,917.51
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem Medicaid |
$955.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Humana KY Medicaid |
$955.70
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$965.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$974.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,917.51
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
ECHO 2D W/COL/DOP W W/WO CONT
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$1,667.40 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Ambetter Exchange |
$175.69
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.83
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$1,667.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.40
|
| Rate for Payer: UHCCP Medicaid |
$972.65
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.69
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$883.20 |
| Max. Negotiated Rate |
$2,826.24 |
| Rate for Payer: Aetna Commercial |
$2,266.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.32
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cigna Commercial |
$2,443.52
|
| Rate for Payer: First Health Commercial |
$2,796.80
|
| Rate for Payer: Humana Commercial |
$2,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,414.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,208.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,561.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.36
|
| Rate for Payer: PHCS Commercial |
$2,826.24
|
| Rate for Payer: United Healthcare All Payer |
$2,590.72
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,826.24 |
| Rate for Payer: Aetna Commercial |
$2,266.88
|
| Rate for Payer: Anthem Medicaid |
$1,012.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cigna Commercial |
$2,443.52
|
| Rate for Payer: First Health Commercial |
$2,796.80
|
| Rate for Payer: Humana Commercial |
$2,502.40
|
| Rate for Payer: Humana KY Medicaid |
$1,012.44
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,414.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,208.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,561.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.36
|
| Rate for Payer: PHCS Commercial |
$2,826.24
|
| Rate for Payer: United Healthcare All Payer |
$2,590.72
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Ambetter Exchange |
$175.69
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.83
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$1,766.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.40
|
| Rate for Payer: UHCCP Medicaid |
$1,030.40
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.69
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Ambetter Exchange |
$175.69
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.83
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.40
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.69
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(T
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$808.20 |
| Max. Negotiated Rate |
$2,586.24 |
| Rate for Payer: Aetna Commercial |
$2,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,101.32
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$2,236.02
|
| Rate for Payer: First Health Commercial |
$2,559.30
|
| Rate for Payer: Humana Commercial |
$2,289.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,370.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,020.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,343.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,858.86
|
| Rate for Payer: PHCS Commercial |
$2,586.24
|
| Rate for Payer: United Healthcare All Payer |
$2,370.72
|
|
|
ECHO 2D W/ COLORFLOW/DOPPLER(T
|
Facility
|
OP
|
$2,694.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483T0003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,586.24 |
| Rate for Payer: Aetna Commercial |
$2,074.38
|
| Rate for Payer: Anthem Medicaid |
$926.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,101.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$2,236.02
|
| Rate for Payer: First Health Commercial |
$2,559.30
|
| Rate for Payer: Humana Commercial |
$2,289.90
|
| Rate for Payer: Humana KY Medicaid |
$926.47
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$935.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,370.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,020.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,343.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,858.86
|
| Rate for Payer: PHCS Commercial |
$2,586.24
|
| Rate for Payer: United Healthcare All Payer |
$2,370.72
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483P0005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$302.43 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Ambetter Exchange |
$122.19
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.63
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.85
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.19
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483P0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$302.43 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Ambetter Exchange |
$122.19
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.63
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.85
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.19
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300004
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,819.20 |
| Rate for Payer: Aetna Commercial |
$1,459.15
|
| Rate for Payer: Anthem Medicaid |
$651.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$1,572.85
|
| Rate for Payer: First Health Commercial |
$1,800.25
|
| Rate for Payer: Humana Commercial |
$1,610.75
|
| Rate for Payer: Humana KY Medicaid |
$651.69
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$658.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,648.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.55
|
| Rate for Payer: PHCS Commercial |
$1,819.20
|
| Rate for Payer: United Healthcare All Payer |
$1,667.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300004
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.80
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$568.50 |
| Max. Negotiated Rate |
$1,819.20 |
| Rate for Payer: Aetna Commercial |
$1,459.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.10
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$1,572.85
|
| Rate for Payer: First Health Commercial |
$1,800.25
|
| Rate for Payer: Humana Commercial |
$1,610.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,648.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.55
|
| Rate for Payer: PHCS Commercial |
$1,819.20
|
| Rate for Payer: United Healthcare All Payer |
$1,667.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem Medicaid |
$557.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Humana KY Medicaid |
$557.12
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$568.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.80
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Professional
|
Both
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Ambetter Exchange |
$122.19
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.63
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cash Price |
$947.50
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$1,137.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.85
|
| Rate for Payer: UHCCP Medicaid |
$663.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.19
|
|
|
ECHO 2D W/O COLORFLOW OR DOPP
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna Commercial |
$284.80
|
| Rate for Payer: Ambetter Exchange |
$122.19
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.63
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$302.43
|
| Rate for Payer: Healthspan PPO |
$267.72
|
| Rate for Payer: Humana Medicaid |
$157.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.30
|
| Rate for Payer: Molina Healthcare Passport |
$157.16
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.85
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.19
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
ECHO 2D W/O COLORFLOW OR DOP(T
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
483T0005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
