|
TREAT FRACTURE OF MALAR AREA
|
Professional
|
Both
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$2,701.20 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Ambetter Exchange |
$309.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.84
|
| Rate for Payer: Anthem Medicaid |
$149.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.62
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$546.94
|
| Rate for Payer: Humana Medicaid |
$149.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.25
|
| Rate for Payer: Molina Healthcare Passport |
$149.26
|
| Rate for Payer: Multiplan PHCS |
$2,701.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.58
|
| Rate for Payer: UHCCP Medicaid |
$176.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.68
|
|
|
TREAT FRACTURE OF MALAR AREA(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761P0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$546.94 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Ambetter Exchange |
$309.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.84
|
| Rate for Payer: Anthem Medicaid |
$149.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.62
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$546.94
|
| Rate for Payer: Humana Medicaid |
$149.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.25
|
| Rate for Payer: Molina Healthcare Passport |
$149.26
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.58
|
| Rate for Payer: UHCCP Medicaid |
$176.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.68
|
|
|
TREAT FRACTURE OF MALAR AREA(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761T0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
TREAT FRACTURE OF MALAR AREA(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761T0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
45000128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
45000128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
76100617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,496.64 |
| Rate for Payer: Aetna Commercial |
$1,200.43
|
| Rate for Payer: Anthem Medicaid |
$536.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$779.50
|
| Rate for Payer: Cash Price |
$779.50
|
| Rate for Payer: Cigna Commercial |
$1,293.97
|
| Rate for Payer: First Health Commercial |
$1,481.05
|
| Rate for Payer: Humana Commercial |
$1,325.15
|
| Rate for Payer: Humana KY Medicaid |
$536.14
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$541.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.71
|
| Rate for Payer: PHCS Commercial |
$1,496.64
|
| Rate for Payer: United Healthcare All Payer |
$1,371.92
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,559.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
76100617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.03 |
| Max. Negotiated Rate |
$935.40 |
| Rate for Payer: Aetna Commercial |
$321.28
|
| Rate for Payer: Ambetter Exchange |
$251.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.90
|
| Rate for Payer: Anthem Medicaid |
$137.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$251.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$251.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$302.02
|
| Rate for Payer: Cash Price |
$779.50
|
| Rate for Payer: Cash Price |
$779.50
|
| Rate for Payer: Cigna Commercial |
$392.05
|
| Rate for Payer: Healthspan PPO |
$317.19
|
| Rate for Payer: Humana Medicaid |
$137.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$251.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.77
|
| Rate for Payer: Molina Healthcare Passport |
$137.03
|
| Rate for Payer: Multiplan PHCS |
$935.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$327.18
|
| Rate for Payer: UHCCP Medicaid |
$144.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$251.68
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
76100617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.70 |
| Max. Negotiated Rate |
$1,496.64 |
| Rate for Payer: Aetna Commercial |
$1,200.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.02
|
| Rate for Payer: Cash Price |
$779.50
|
| Rate for Payer: Cigna Commercial |
$1,293.97
|
| Rate for Payer: First Health Commercial |
$1,481.05
|
| Rate for Payer: Humana Commercial |
$1,325.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.71
|
| Rate for Payer: PHCS Commercial |
$1,496.64
|
| Rate for Payer: United Healthcare All Payer |
$1,371.92
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$2,981.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
76100618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.69 |
| Max. Negotiated Rate |
$1,788.60 |
| Rate for Payer: Aetna Commercial |
$645.11
|
| Rate for Payer: Ambetter Exchange |
$444.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.50
|
| Rate for Payer: Anthem Medicaid |
$253.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$444.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$444.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$533.99
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cigna Commercial |
$773.08
|
| Rate for Payer: Healthspan PPO |
$627.97
|
| Rate for Payer: Humana Medicaid |
$253.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.76
|
| Rate for Payer: Molina Healthcare Passport |
$253.69
|
| Rate for Payer: Multiplan PHCS |
$1,788.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$578.49
|
| Rate for Payer: UHCCP Medicaid |
$268.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$444.99
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,981.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
76100618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.30 |
| Max. Negotiated Rate |
$2,861.76 |
| Rate for Payer: Aetna Commercial |
$2,295.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.18
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cigna Commercial |
$2,474.23
|
| Rate for Payer: First Health Commercial |
$2,831.95
|
| Rate for Payer: Humana Commercial |
$2,533.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,444.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,199.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,623.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,235.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.89
|
| Rate for Payer: PHCS Commercial |
$2,861.76
|
| Rate for Payer: United Healthcare All Payer |
$2,623.28
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$2,981.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
76100618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,025.17 |
| Max. Negotiated Rate |
$2,861.76 |
| Rate for Payer: Aetna Commercial |
$2,295.37
|
| Rate for Payer: Anthem Medicaid |
$1,025.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cigna Commercial |
$2,474.23
|
| Rate for Payer: First Health Commercial |
$2,831.95
|
| Rate for Payer: Humana Commercial |
$2,533.85
|
| Rate for Payer: Humana KY Medicaid |
$1,025.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,035.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,444.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,199.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,045.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,623.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,235.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.89
|
| Rate for Payer: PHCS Commercial |
$2,861.76
|
| Rate for Payer: United Healthcare All Payer |
$2,623.28
|
|
|
TREAT FRACTURE OF RADIUS(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761P0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.03 |
| Max. Negotiated Rate |
$392.05 |
| Rate for Payer: Aetna Commercial |
$321.28
|
| Rate for Payer: Ambetter Exchange |
$251.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.90
|
| Rate for Payer: Anthem Medicaid |
$137.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$251.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$251.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$302.02
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$392.05
|
| Rate for Payer: Healthspan PPO |
$317.19
|
| Rate for Payer: Humana Medicaid |
$137.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$251.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.77
|
| Rate for Payer: Molina Healthcare Passport |
$137.03
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$327.18
|
| Rate for Payer: UHCCP Medicaid |
$144.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$251.68
|
|
|
TREAT FRACTURE OF RADIUS(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761P0618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.69 |
| Max. Negotiated Rate |
$773.08 |
| Rate for Payer: Aetna Commercial |
$645.11
|
| Rate for Payer: Ambetter Exchange |
$444.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.50
|
| Rate for Payer: Anthem Medicaid |
$253.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$444.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$444.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$533.99
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$773.08
|
| Rate for Payer: Healthspan PPO |
$627.97
|
| Rate for Payer: Humana Medicaid |
$253.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.76
|
| Rate for Payer: Molina Healthcare Passport |
$253.69
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$578.49
|
| Rate for Payer: UHCCP Medicaid |
$268.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$444.99
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761T0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem Medicaid |
$329.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Humana KY Medicaid |
$329.80
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$333.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761T0618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761T0618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761T0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.70 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$2,109.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
45000129
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Aetna Commercial |
$1,623.93
|
| Rate for Payer: Anthem Medicaid |
$725.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cigna Commercial |
$1,750.47
|
| Rate for Payer: First Health Commercial |
$2,003.55
|
| Rate for Payer: Humana Commercial |
$1,792.65
|
| Rate for Payer: Humana KY Medicaid |
$725.29
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$732.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.21
|
| Rate for Payer: PHCS Commercial |
$2,024.64
|
| Rate for Payer: United Healthcare All Payer |
$1,855.92
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$2,109.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
45000129
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$632.70 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Aetna Commercial |
$1,623.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.02
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cigna Commercial |
$1,750.47
|
| Rate for Payer: First Health Commercial |
$2,003.55
|
| Rate for Payer: Humana Commercial |
$1,792.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.21
|
| Rate for Payer: PHCS Commercial |
$2,024.64
|
| Rate for Payer: United Healthcare All Payer |
$1,855.92
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$3,009.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$1,805.40 |
| Rate for Payer: Aetna Commercial |
$634.44
|
| Rate for Payer: Ambetter Exchange |
$440.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.28
|
| Rate for Payer: Anthem Medicaid |
$252.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$440.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$528.76
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$694.80
|
| Rate for Payer: Healthspan PPO |
$609.57
|
| Rate for Payer: Humana Medicaid |
$252.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$440.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.01
|
| Rate for Payer: Molina Healthcare Passport |
$252.95
|
| Rate for Payer: Multiplan PHCS |
$1,805.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.82
|
| Rate for Payer: UHCCP Medicaid |
$263.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$440.63
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem Medicaid |
$1,034.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Humana KY Medicaid |
$1,034.80
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,045.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,617.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.21
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem Medicaid |
$436.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,053.27
|
| Rate for Payer: First Health Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial |
$1,078.65
|
| Rate for Payer: Humana KY Medicaid |
$436.41
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$440.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,040.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$936.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,116.72
|
| Rate for Payer: Ohio Health Group HMO |
$951.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.61
|
| Rate for Payer: PHCS Commercial |
$1,218.24
|
| Rate for Payer: United Healthcare All Payer |
$1,116.72
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.70 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,053.27
|
| Rate for Payer: First Health Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial |
$1,078.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,040.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$936.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,116.72
|
| Rate for Payer: Ohio Health Group HMO |
$951.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.61
|
| Rate for Payer: PHCS Commercial |
$1,218.24
|
| Rate for Payer: United Healthcare All Payer |
$1,116.72
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Aetna Commercial |
$306.20
|
| Rate for Payer: Ambetter Exchange |
$237.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.84
|
| Rate for Payer: Anthem Medicaid |
$130.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$237.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.93
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$380.62
|
| Rate for Payer: Healthspan PPO |
$306.44
|
| Rate for Payer: Humana Medicaid |
$130.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$237.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.50
|
| Rate for Payer: Molina Healthcare Passport |
$130.88
|
| Rate for Payer: Multiplan PHCS |
$761.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.67
|
| Rate for Payer: UHCCP Medicaid |
$137.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.44
|
|
