|
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
|
|
|
ECHO GUIDE FOR ARTERY REPAI(P
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402P0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$500.11 |
| Rate for Payer: Aetna Commercial |
$306.08
|
| Rate for Payer: Ambetter Exchange |
$234.17
|
| Rate for Payer: Anthem Medicaid |
$264.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$500.11
|
| Rate for Payer: Healthspan PPO |
$286.80
|
| Rate for Payer: Humana Medicaid |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Molina Healthcare Passport |
$264.25
|
| Rate for Payer: Multiplan PHCS |
$249.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.42
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.17
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$1,599.36 |
| Rate for Payer: Aetna Commercial |
$1,282.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,299.48
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$1,382.78
|
| Rate for Payer: First Health Commercial |
$1,582.70
|
| Rate for Payer: Humana Commercial |
$1,416.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,366.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,229.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,466.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,249.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.54
|
| Rate for Payer: PHCS Commercial |
$1,599.36
|
| Rate for Payer: United Healthcare All Payer |
$1,466.08
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Professional
|
Both
|
$1,666.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: Aetna Commercial |
$306.08
|
| Rate for Payer: Ambetter Exchange |
$234.17
|
| Rate for Payer: Anthem Medicaid |
$264.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.00
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$500.11
|
| Rate for Payer: Healthspan PPO |
$286.80
|
| Rate for Payer: Humana Medicaid |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Molina Healthcare Passport |
$264.25
|
| Rate for Payer: Multiplan PHCS |
$999.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.42
|
| Rate for Payer: UHCCP Medicaid |
$583.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.17
|
|
|
ECHO GUIDE FOR ARTERY REPAIR
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
40200066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,599.36 |
| Rate for Payer: Aetna Commercial |
$1,282.82
|
| Rate for Payer: Anthem Medicaid |
$572.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,299.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$1,382.78
|
| Rate for Payer: First Health Commercial |
$1,582.70
|
| Rate for Payer: Humana Commercial |
$1,416.10
|
| Rate for Payer: Humana KY Medicaid |
$572.94
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$578.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,366.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,229.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$584.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,466.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,249.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.54
|
| Rate for Payer: PHCS Commercial |
$1,599.36
|
| Rate for Payer: United Healthcare All Payer |
$1,466.08
|
|
|
ECHO GUIDE FOR ARTERY REPAI(T
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402T0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem Medicaid |
$430.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Humana KY Medicaid |
$430.22
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,088.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$863.19
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
ECHO GUIDE FOR ARTERY REPAI(T
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
402T0066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$375.30 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,088.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$863.19
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
OP
|
$3,451.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,312.96 |
| Rate for Payer: Aetna Commercial |
$2,657.27
|
| Rate for Payer: Anthem Medicaid |
$1,186.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$2,864.33
|
| Rate for Payer: First Health Commercial |
$3,278.45
|
| Rate for Payer: Humana Commercial |
$2,933.35
|
| Rate for Payer: Humana KY Medicaid |
$1,186.80
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,198.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,210.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.19
|
| Rate for Payer: PHCS Commercial |
$3,312.96
|
| Rate for Payer: United Healthcare All Payer |
$3,036.88
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
IP
|
$3,451.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,035.30 |
| Max. Negotiated Rate |
$3,312.96 |
| Rate for Payer: Aetna Commercial |
$2,657.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.78
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$2,864.33
|
| Rate for Payer: First Health Commercial |
$3,278.45
|
| Rate for Payer: Humana Commercial |
$2,933.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.19
|
| Rate for Payer: PHCS Commercial |
$3,312.96
|
| Rate for Payer: United Healthcare All Payer |
$3,036.88
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483P0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$87.73
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.28
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.05
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.73
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Professional
|
Both
|
$3,451.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$2,070.60 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$87.73
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.28
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$2,070.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.05
|
| Rate for Payer: UHCCP Medicaid |
$1,207.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.73
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
IP
|
$3,366.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483T0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$3,231.36 |
| Rate for Payer: Aetna Commercial |
$2,591.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,625.48
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna Commercial |
$2,793.78
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: Humana Commercial |
$2,861.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,760.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,484.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,962.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,928.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.54
|
| Rate for Payer: PHCS Commercial |
$3,231.36
|
| Rate for Payer: United Healthcare All Payer |
$2,962.08
|
|
|
ECHO LIMITED W/WO CONTRAST
|
Facility
|
OP
|
$3,366.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483T0012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,231.36 |
| Rate for Payer: Aetna Commercial |
$2,591.82
|
| Rate for Payer: Anthem Medicaid |
$1,157.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,625.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna Commercial |
$2,793.78
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: Humana Commercial |
$2,861.10
|
| Rate for Payer: Humana KY Medicaid |
$1,157.57
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,169.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,760.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,484.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,180.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,962.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,928.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.54
|
| Rate for Payer: PHCS Commercial |
$3,231.36
|
| Rate for Payer: United Healthcare All Payer |
$2,962.08
|
|
|
ECHO LTD
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem Medicaid |
$387.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Humana KY Medicaid |
$387.58
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$391.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$901.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.63
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO LTD
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$1,081.92 |
| Rate for Payer: Aetna Commercial |
$867.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.06
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cigna Commercial |
$935.41
|
| Rate for Payer: First Health Commercial |
$1,070.65
|
| Rate for Payer: Humana Commercial |
$957.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$831.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$991.76
|
| Rate for Payer: Ohio Health Group HMO |
$845.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$901.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.63
|
| Rate for Payer: PHCS Commercial |
$1,081.92
|
| Rate for Payer: United Healthcare All Payer |
$991.76
|
|
|
ECHO LTD - FOLLOWUP
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$771.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$87.73
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.28
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$771.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.05
|
| Rate for Payer: UHCCP Medicaid |
$449.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.73
|
|
|
ECHO LTD - FOLLOWUP
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$1,233.60 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$886.65
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
ECHO LTD - FOLLOWUP
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,233.60 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem Medicaid |
$441.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Humana KY Medicaid |
$441.91
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$446.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$450.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$886.65
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
ECHO LTD - FOLLOWUP(P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483P0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$87.73
|
| Rate for Payer: Anthem Medicaid |
$88.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.28
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$168.48
|
| Rate for Payer: Healthspan PPO |
$168.57
|
| Rate for Payer: Humana Medicaid |
$88.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.79
|
| Rate for Payer: Molina Healthcare Passport |
$88.03
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.05
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.73
|
|
|
ECHO LTD - FOLLOWUP(T
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483T0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
ECHO LTD - FOLLOWUP(T
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
483T0008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
ECHO MYOCARDIAL STRAIN
|
Facility
|
IP
|
$67.06
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
48000111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$64.38 |
| Rate for Payer: Aetna Commercial |
$51.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.31
|
| Rate for Payer: Cash Price |
$33.53
|
| Rate for Payer: Cigna Commercial |
$55.66
|
| Rate for Payer: First Health Commercial |
$63.71
|
| Rate for Payer: Humana Commercial |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.01
|
| Rate for Payer: Ohio Health Group HMO |
$50.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.27
|
| Rate for Payer: PHCS Commercial |
$64.38
|
| Rate for Payer: United Healthcare All Payer |
$59.01
|
|
|
ECHO MYOCARDIAL STRAIN
|
Facility
|
OP
|
$67.06
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
48000111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$64.38 |
| Rate for Payer: Aetna Commercial |
$51.64
|
| Rate for Payer: Anthem Medicaid |
$23.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.31
|
| Rate for Payer: Cash Price |
$33.53
|
| Rate for Payer: Cigna Commercial |
$55.66
|
| Rate for Payer: First Health Commercial |
$63.71
|
| Rate for Payer: Humana Commercial |
$57.00
|
| Rate for Payer: Humana KY Medicaid |
$23.06
|
| Rate for Payer: Kentucky WC Medicaid |
$23.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.01
|
| Rate for Payer: Ohio Health Group HMO |
$50.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.27
|
| Rate for Payer: PHCS Commercial |
$64.38
|
| Rate for Payer: United Healthcare All Payer |
$59.01
|
|
|
ECHO MYOCARDIAL STRAIN
|
Professional
|
Both
|
$67.06
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
48000111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$40.24 |
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$30.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$33.53
|
| Rate for Payer: Cash Price |
$33.53
|
| Rate for Payer: Humana Medicaid |
$30.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.67
|
| Rate for Payer: Molina Healthcare Passport |
$30.07
|
| Rate for Payer: Multiplan PHCS |
$40.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$10.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
