|
EKG REGULAR(P INTERP REPORT
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
730P0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Ambetter Exchange |
$7.60
|
| Rate for Payer: Anthem Medicaid |
$9.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.12
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$13.30
|
| Rate for Payer: Healthspan PPO |
$14.09
|
| Rate for Payer: Humana Medicaid |
$9.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Molina Healthcare Passport |
$9.52
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.88
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.60
|
|
|
EKG REGULAR(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
EKG REGULAR(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
730T0003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem Medicaid |
$6.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Humana KY Medicaid |
$6.53
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EKG W/O INTERP SLIM&TRIM
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
30001785
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Ambetter Exchange |
$5.64
|
| Rate for Payer: Anthem Medicaid |
$12.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.77
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$24.77
|
| Rate for Payer: Healthspan PPO |
$17.77
|
| Rate for Payer: Humana Medicaid |
$12.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.51
|
| Rate for Payer: Molina Healthcare Passport |
$12.26
|
| Rate for Payer: Multiplan PHCS |
$11.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$6.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.64
|
|
|
EKOS + KIT 106CM*12CM
|
Facility
|
IP
|
$16,961.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,088.45 |
| Max. Negotiated Rate |
$16,283.04 |
| Rate for Payer: Aetna Commercial |
$13,060.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,229.97
|
| Rate for Payer: Cash Price |
$8,480.75
|
| Rate for Payer: Cigna Commercial |
$14,078.05
|
| Rate for Payer: First Health Commercial |
$16,113.42
|
| Rate for Payer: Humana Commercial |
$14,417.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,908.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,517.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,088.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,926.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,721.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,569.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,756.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,703.43
|
| Rate for Payer: PHCS Commercial |
$16,283.04
|
| Rate for Payer: United Healthcare All Payer |
$14,926.12
|
|
|
EKOS + KIT 106CM*12CM
|
Facility
|
OP
|
$16,961.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,088.45 |
| Max. Negotiated Rate |
$16,283.04 |
| Rate for Payer: Aetna Commercial |
$13,060.35
|
| Rate for Payer: Anthem Medicaid |
$5,833.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,229.97
|
| Rate for Payer: Cash Price |
$8,480.75
|
| Rate for Payer: Cigna Commercial |
$14,078.05
|
| Rate for Payer: First Health Commercial |
$16,113.42
|
| Rate for Payer: Humana Commercial |
$14,417.27
|
| Rate for Payer: Humana KY Medicaid |
$5,833.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,892.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,908.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,517.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,088.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,950.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,926.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,721.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,569.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,756.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,703.43
|
| Rate for Payer: PHCS Commercial |
$16,283.04
|
| Rate for Payer: United Healthcare All Payer |
$14,926.12
|
|
|
EKO SONIC 40CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC 40CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC 50CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC 50CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 12CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 12CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 18CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 18CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 24CM
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
EKO SONIC MACH 4 24CM
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
EKO SONIC MACH 4 30CM
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
EKO SONIC MACH 4 30CM
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
EKO SONIC MACH 4 6CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
EKO SONIC MACH 4 6CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
ELATION PUL BALL DIL 2CM 10-11
|
Facility
|
IP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
ELATION PUL BALL DIL 2CM 10-11
|
Facility
|
OP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem Medicaid |
$1,042.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Humana KY Medicaid |
$1,042.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
ELATION PUL BALL DIL 2CM 12-13
|
Facility
|
IP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
