|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
OP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483T0011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,030.72 |
| Rate for Payer: Aetna Commercial |
$2,430.89
|
| Rate for Payer: Anthem Medicaid |
$1,085.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,462.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cigna Commercial |
$2,620.31
|
| Rate for Payer: First Health Commercial |
$2,999.15
|
| Rate for Payer: Humana Commercial |
$2,683.45
|
| Rate for Payer: Humana KY Medicaid |
$1,085.69
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,096.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,588.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,329.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,107.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,778.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,367.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,525.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.33
|
| Rate for Payer: PHCS Commercial |
$3,030.72
|
| Rate for Payer: United Healthcare All Payer |
$2,778.16
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: 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 COMPLETE W/WO CONTRAST
|
Professional
|
Both
|
$3,407.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$2,044.20 |
| 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 |
$1,703.50
|
| Rate for Payer: Cash Price |
$1,703.50
|
| 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 |
$2,044.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.40
|
| Rate for Payer: UHCCP Medicaid |
$1,192.45
|
| 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 COMPLETE W/WO CONTRAST
|
Facility
|
OP
|
$3,407.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna Commercial |
$2,623.39
|
| Rate for Payer: Anthem Medicaid |
$1,171.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,703.50
|
| Rate for Payer: Cash Price |
$1,703.50
|
| Rate for Payer: Cigna Commercial |
$2,827.81
|
| Rate for Payer: First Health Commercial |
$3,236.65
|
| Rate for Payer: Humana Commercial |
$2,895.95
|
| Rate for Payer: Humana KY Medicaid |
$1,171.67
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.83
|
| Rate for Payer: PHCS Commercial |
$3,270.72
|
| Rate for Payer: United Healthcare All Payer |
$2,998.16
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
IP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483T0011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$947.10 |
| Max. Negotiated Rate |
$3,030.72 |
| Rate for Payer: Aetna Commercial |
$2,430.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,462.46
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cigna Commercial |
$2,620.31
|
| Rate for Payer: First Health Commercial |
$2,999.15
|
| Rate for Payer: Humana Commercial |
$2,683.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,588.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,329.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$947.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,778.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,367.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,525.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.33
|
| Rate for Payer: PHCS Commercial |
$3,030.72
|
| Rate for Payer: United Healthcare All Payer |
$2,778.16
|
|
|
ECHO COMPLETE W/WO CONTRAST
|
Facility
|
IP
|
$3,407.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300011
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,022.10 |
| Max. Negotiated Rate |
$3,270.72 |
| Rate for Payer: Aetna Commercial |
$2,623.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.46
|
| Rate for Payer: Cash Price |
$1,703.50
|
| Rate for Payer: Cigna Commercial |
$2,827.81
|
| Rate for Payer: First Health Commercial |
$3,236.65
|
| Rate for Payer: Humana Commercial |
$2,895.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.83
|
| Rate for Payer: PHCS Commercial |
$3,270.72
|
| Rate for Payer: United Healthcare All Payer |
$2,998.16
|
|
|
ECHO CONGENITAL
|
Professional
|
Both
|
$2,423.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$1,453.80 |
| Rate for Payer: Aetna Commercial |
$350.74
|
| Rate for Payer: Ambetter Exchange |
$194.09
|
| Rate for Payer: Anthem Medicaid |
$166.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.91
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$341.80
|
| Rate for Payer: Healthspan PPO |
$329.70
|
| Rate for Payer: Humana Medicaid |
$166.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.21
|
| Rate for Payer: Molina Healthcare Passport |
$166.87
|
| Rate for Payer: Multiplan PHCS |
$1,453.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.32
|
| Rate for Payer: UHCCP Medicaid |
$848.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.09
|
|
|
ECHO CONGENITAL
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$726.90 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,108.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,671.87
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
ECHO CONGENITAL
|
Facility
|
IP
|
$1,394.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,338.24 |
| Rate for Payer: Aetna Commercial |
$1,073.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.32
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cigna Commercial |
$1,157.02
|
| Rate for Payer: First Health Commercial |
$1,324.30
|
| Rate for Payer: Humana Commercial |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.86
|
| Rate for Payer: PHCS Commercial |
$1,338.24
|
| Rate for Payer: United Healthcare All Payer |
$1,226.72
|
|
|
ECHO CONGENITAL
|
Facility
|
OP
|
$1,394.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$1,338.24 |
| Rate for Payer: Aetna Commercial |
$1,073.38
|
| Rate for Payer: Anthem Medicaid |
$479.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cash Price |
$697.00
|
| Rate for Payer: Cigna Commercial |
$1,157.02
|
| Rate for Payer: First Health Commercial |
$1,324.30
|
| Rate for Payer: Humana Commercial |
$1,184.90
|
| Rate for Payer: Humana KY Medicaid |
$479.40
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$484.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$489.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.86
|
| Rate for Payer: PHCS Commercial |
$1,338.24
|
| Rate for Payer: United Healthcare All Payer |
$1,226.72
|
|
|
ECHO CONGENITAL
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
48000112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem Medicaid |
$833.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Humana KY Medicaid |
$833.27
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$841.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,108.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,671.87
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
ECHO CONGENITAL LIMITED
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$489.71 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem Medicaid |
$489.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Humana KY Medicaid |
$489.71
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,238.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.56
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
ECHO CONGENITAL LIMITED
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$854.40 |
| Rate for Payer: Aetna Commercial |
$216.27
|
| Rate for Payer: Ambetter Exchange |
$136.10
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.32
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$191.70
|
| Rate for Payer: Healthspan PPO |
$203.30
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$854.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.93
|
| Rate for Payer: UHCCP Medicaid |
$498.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.10
|
|
|
ECHO CONGENITAL LIMITED
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48000113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$427.20 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,238.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.56
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
ECHO CONGENITAL LIMITED (P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480P0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$216.27 |
| Rate for Payer: Aetna Commercial |
$216.27
|
| Rate for Payer: Ambetter Exchange |
$136.10
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.32
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$191.70
|
| Rate for Payer: Healthspan PPO |
$203.30
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.93
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.10
|
|
|
ECHO CONGENITAL LIMITED (T
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480T0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$356.70 |
| Max. Negotiated Rate |
$1,141.44 |
| Rate for Payer: Aetna Commercial |
$915.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$927.42
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$986.87
|
| Rate for Payer: First Health Commercial |
$1,129.55
|
| Rate for Payer: Humana Commercial |
$1,010.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,046.32
|
| Rate for Payer: Ohio Health Group HMO |
$891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$820.41
|
| Rate for Payer: PHCS Commercial |
$1,141.44
|
| Rate for Payer: United Healthcare All Payer |
$1,046.32
|
|
|
ECHO CONGENITAL LIMITED (T
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
480T0113
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$408.90 |
| Max. Negotiated Rate |
$1,141.44 |
| Rate for Payer: Aetna Commercial |
$915.53
|
| Rate for Payer: Anthem Medicaid |
$408.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$927.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$986.87
|
| Rate for Payer: First Health Commercial |
$1,129.55
|
| Rate for Payer: Humana Commercial |
$1,010.65
|
| Rate for Payer: Humana KY Medicaid |
$408.90
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$413.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,046.32
|
| Rate for Payer: Ohio Health Group HMO |
$891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$820.41
|
| Rate for Payer: PHCS Commercial |
$1,141.44
|
| Rate for Payer: United Healthcare All Payer |
$1,046.32
|
|
|
ECHO CONGENITAL LTD/FOLLOWUP
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$1,021.44 |
| Rate for Payer: Aetna Commercial |
$819.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$829.92
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cigna Commercial |
$883.12
|
| Rate for Payer: First Health Commercial |
$1,010.80
|
| Rate for Payer: Humana Commercial |
$904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$872.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$936.32
|
| Rate for Payer: Ohio Health Group HMO |
$798.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.16
|
| Rate for Payer: PHCS Commercial |
$1,021.44
|
| Rate for Payer: United Healthcare All Payer |
$936.32
|
|
|
ECHO CONGENITAL LTD/FOLLOWUP
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
HCPCS 93304
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$365.91 |
| Max. Negotiated Rate |
$1,021.44 |
| Rate for Payer: Aetna Commercial |
$819.28
|
| Rate for Payer: Anthem Medicaid |
$365.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$829.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cigna Commercial |
$883.12
|
| Rate for Payer: First Health Commercial |
$1,010.80
|
| Rate for Payer: Humana Commercial |
$904.40
|
| Rate for Payer: Humana KY Medicaid |
$365.91
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$369.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$872.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$936.32
|
| Rate for Payer: Ohio Health Group HMO |
$798.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.16
|
| Rate for Payer: PHCS Commercial |
$1,021.44
|
| Rate for Payer: United Healthcare All Payer |
$936.32
|
|
|
ECHO CONGENITAL (P
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480P0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$350.74 |
| Rate for Payer: Aetna Commercial |
$350.74
|
| Rate for Payer: Ambetter Exchange |
$194.09
|
| Rate for Payer: Anthem Medicaid |
$166.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.91
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$341.80
|
| Rate for Payer: Healthspan PPO |
$329.70
|
| Rate for Payer: Humana Medicaid |
$166.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.21
|
| Rate for Payer: Molina Healthcare Passport |
$166.87
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.32
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.09
|
|
|
ECHO CONGENITAL (T
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480T0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,878.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.71
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
ECHO CONGENITAL (T
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
480T0112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem Medicaid |
$742.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Humana KY Medicaid |
$742.48
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$750.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,878.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.71
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
ECHO DOPPLER LIMITED
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
480T0109
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$536.64 |
| Rate for Payer: Aetna Commercial |
$430.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.02
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cigna Commercial |
$463.97
|
| Rate for Payer: First Health Commercial |
$531.05
|
| Rate for Payer: Humana Commercial |
$475.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.92
|
| Rate for Payer: Ohio Health Group HMO |
$419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.71
|
| Rate for Payer: PHCS Commercial |
$536.64
|
| Rate for Payer: United Healthcare All Payer |
$491.92
|
|
|
ECHO DOPPLER LIMITED
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000109
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Aetna Commercial |
$56.85
|
| Rate for Payer: Ambetter Exchange |
$22.28
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.74
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cigna Commercial |
$73.18
|
| Rate for Payer: Healthspan PPO |
$53.44
|
| Rate for Payer: Humana Medicaid |
$40.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.41
|
| Rate for Payer: Molina Healthcare Passport |
$40.60
|
| Rate for Payer: Multiplan PHCS |
$335.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.96
|
| Rate for Payer: UHCCP Medicaid |
$195.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.28
|
|
|
ECHO DOPPLER LIMITED
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000109
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$536.64 |
| Rate for Payer: Aetna Commercial |
$430.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.02
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cigna Commercial |
$463.97
|
| Rate for Payer: First Health Commercial |
$531.05
|
| Rate for Payer: Humana Commercial |
$475.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.92
|
| Rate for Payer: Ohio Health Group HMO |
$419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.71
|
| Rate for Payer: PHCS Commercial |
$536.64
|
| Rate for Payer: United Healthcare All Payer |
$491.92
|
|
