|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
30001784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
30001784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
SARSCOV2 & INF A&B AMP PRB
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
30002065
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem Medicaid |
$142.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$142.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$199.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.63
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Humana KY Medicaid |
$142.63
|
| Rate for Payer: Humana Medicare Advantage |
$142.63
|
| Rate for Payer: Kentucky WC Medicaid |
$144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
SARSCOV2 & INF A&B AMP PRB
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
30002065
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$316.38
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
SARS-COV-2 RAPID COVID-19 AMP
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.41
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
SARS-COV-2 RAPID COVID-19 AMP
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
SARS-COV-2 RAPID COVID-19 AMP
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Ambetter Exchange |
$51.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.57
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.31
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.70
|
| Rate for Payer: UHCCP Medicaid |
$47.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.31
|
|
|
S AUREUS GYRB GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
S AUREUS GYRB GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SAVARY-GILLIARD WIRE GUIDE 250
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
SAVARY-GILLIARD WIRE GUIDE 250
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
SAVI-06 GAMMA KIT
|
Facility
|
OP
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.50 |
| Max. Negotiated Rate |
$11,035.20 |
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Aetna Commercial |
$9,853.97
|
| Rate for Payer: Anthem Medicaid |
$3,953.13
|
| Rate for Payer: Anthem Medicaid |
$4,401.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.94
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cash Price |
$6,398.68
|
| Rate for Payer: Cigna Commercial |
$10,621.81
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$12,157.49
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Humana Commercial |
$10,877.76
|
| Rate for Payer: Humana KY Medicaid |
$3,953.13
|
| Rate for Payer: Humana KY Medicaid |
$4,401.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,445.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,993.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,032.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,489.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group HMO |
$9,598.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,830.18
|
| Rate for Payer: PHCS Commercial |
$12,285.47
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: United Healthcare All Payer |
$11,261.68
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-06 GAMMA KIT
|
Professional
|
Both
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,023.25 |
| Max. Negotiated Rate |
$8,046.50 |
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Multiplan PHCS |
$6,897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,046.50
|
| Rate for Payer: UHCCP Medicaid |
$4,023.25
|
|
|
SAVI-06 GAMMA KIT
|
Facility
|
IP
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.50 |
| Max. Negotiated Rate |
$11,035.20 |
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Aetna Commercial |
$9,853.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.94
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cash Price |
$6,398.68
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: Cigna Commercial |
$10,621.81
|
| Rate for Payer: First Health Commercial |
$12,157.49
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group HMO |
$9,598.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,830.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: PHCS Commercial |
$12,285.47
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
| Rate for Payer: United Healthcare All Payer |
$11,261.68
|
|
|
SAVI-06 MINIGAMMA KIT
|
Facility
|
IP
|
$12,797.36
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,839.21 |
| Max. Negotiated Rate |
$12,285.47 |
| Rate for Payer: Aetna Commercial |
$9,853.97
|
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Cash Price |
$6,398.68
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cigna Commercial |
$10,621.81
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$12,157.49
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.68
|
| Rate for Payer: Ohio Health Group HMO |
$9,598.02
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,830.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: PHCS Commercial |
$12,285.47
|
| Rate for Payer: United Healthcare All Payer |
$11,261.68
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-06 MINIGAMMA KIT
|
Professional
|
Both
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,023.25 |
| Max. Negotiated Rate |
$8,046.50 |
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Multiplan PHCS |
$6,897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,046.50
|
| Rate for Payer: UHCCP Medicaid |
$4,023.25
|
|
|
SAVI-06 MINIGAMMA KIT
|
Facility
|
OP
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.50 |
| Max. Negotiated Rate |
$11,035.20 |
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Aetna Commercial |
$9,853.97
|
| Rate for Payer: Anthem Medicaid |
$3,953.13
|
| Rate for Payer: Anthem Medicaid |
$4,401.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.94
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cash Price |
$6,398.68
|
| Rate for Payer: Cigna Commercial |
$10,621.81
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$12,157.49
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Humana Commercial |
$10,877.76
|
| Rate for Payer: Humana KY Medicaid |
$3,953.13
|
| Rate for Payer: Humana KY Medicaid |
$4,401.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,445.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,993.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,032.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,489.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group HMO |
$9,598.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,830.18
|
| Rate for Payer: PHCS Commercial |
$12,285.47
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: United Healthcare All Payer |
$11,261.68
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-08 GAMMA KIT
|
Facility
|
OP
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.50 |
| Max. Negotiated Rate |
$11,035.20 |
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$3,953.13
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$3,953.13
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,993.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,032.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-08 GAMMA KIT
|
Professional
|
Both
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,023.25 |
| Max. Negotiated Rate |
$8,046.50 |
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Multiplan PHCS |
$6,897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,046.50
|
| Rate for Payer: UHCCP Medicaid |
$4,023.25
|
|
|
SAVI-08 GAMMA KIT
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-10 GAMMA KIT
|
Professional
|
Both
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,023.25 |
| Max. Negotiated Rate |
$8,046.50 |
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Multiplan PHCS |
$6,897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,046.50
|
| Rate for Payer: UHCCP Medicaid |
$4,023.25
|
|
|
SAVI-10 GAMMA KIT
|
Facility
|
OP
|
$11,495.00
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.50 |
| Max. Negotiated Rate |
$11,035.20 |
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Aetna Commercial |
$9,513.05
|
| Rate for Payer: Anthem Medicaid |
$3,953.13
|
| Rate for Payer: Anthem Medicaid |
$4,248.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,636.60
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cash Price |
$6,177.30
|
| Rate for Payer: Cigna Commercial |
$10,254.33
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$11,736.88
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Humana Commercial |
$10,501.42
|
| Rate for Payer: Humana KY Medicaid |
$3,953.13
|
| Rate for Payer: Humana KY Medicaid |
$4,248.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,291.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,993.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,130.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,117.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,706.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,032.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,334.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,872.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group HMO |
$9,265.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,883.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,748.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,524.68
|
| Rate for Payer: PHCS Commercial |
$11,860.43
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: United Healthcare All Payer |
$10,872.06
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVI-10 GAMMA KIT
|
Facility
|
IP
|
$12,354.61
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,706.38 |
| Max. Negotiated Rate |
$11,860.43 |
| Rate for Payer: Aetna Commercial |
$9,513.05
|
| Rate for Payer: Aetna Commercial |
$8,851.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,636.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,966.10
|
| Rate for Payer: Cash Price |
$6,177.30
|
| Rate for Payer: Cash Price |
$5,747.50
|
| Rate for Payer: Cigna Commercial |
$10,254.33
|
| Rate for Payer: Cigna Commercial |
$9,540.85
|
| Rate for Payer: First Health Commercial |
$11,736.88
|
| Rate for Payer: First Health Commercial |
$10,920.25
|
| Rate for Payer: Humana Commercial |
$10,501.42
|
| Rate for Payer: Humana Commercial |
$9,770.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,425.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,130.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,117.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,483.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,706.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,115.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,872.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,265.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,883.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,000.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,748.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,524.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,931.55
|
| Rate for Payer: PHCS Commercial |
$11,035.20
|
| Rate for Payer: PHCS Commercial |
$11,860.43
|
| Rate for Payer: United Healthcare All Payer |
$10,872.06
|
| Rate for Payer: United Healthcare All Payer |
$10,115.60
|
|
|
SAVION FLEX WIRE 300CM
|
Facility
|
IP
|
$2,102.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.71 |
| Max. Negotiated Rate |
$2,018.28 |
| Rate for Payer: Aetna Commercial |
$1,618.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.85
|
| Rate for Payer: Cash Price |
$1,051.18
|
| Rate for Payer: Cigna Commercial |
$1,744.97
|
| Rate for Payer: First Health Commercial |
$1,997.25
|
| Rate for Payer: Humana Commercial |
$1,787.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.64
|
| Rate for Payer: PHCS Commercial |
$2,018.28
|
| Rate for Payer: United Healthcare All Payer |
$1,850.09
|
|
