|
BREAST IMP X-FL SMTH SFT TCH 4
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST IMP X-FL SMTH SFT TCH 4
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
BREAST IMP X-FL SMTH SFT TCH 5
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST IMP X-FL SMTH SFT TCH 5
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST IMP X-FL SMTH SFT TCH 6
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST IMP X-FL SMTH SFT TCH 6
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
BREAST IMP X-FL SMTH SFT TCH 7
|
Facility
|
IP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST IMP X-FL SMTH SFT TCH 7
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BREAST MEMORYSHAPE L MOD+145CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+145CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+170CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+170CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+195CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+195CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+225CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+225CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+255CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+255CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+290CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE L MOD+290CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE M MOD+140CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE M MOD+140CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE M MOD+165CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE M MOD+165CC
|
Facility
|
IP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
|
BREAST MEMORYSHAPE M MOD+195CC
|
Facility
|
OP
|
$8,183.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.90 |
| Max. Negotiated Rate |
$7,855.68 |
| Rate for Payer: Aetna Commercial |
$6,300.91
|
| Rate for Payer: Anthem Medicaid |
$2,814.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,382.74
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cigna Commercial |
$6,791.89
|
| Rate for Payer: First Health Commercial |
$7,773.85
|
| Rate for Payer: Humana Commercial |
$6,955.55
|
| Rate for Payer: Humana KY Medicaid |
$2,814.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,842.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,454.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,119.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,646.27
|
| Rate for Payer: PHCS Commercial |
$7,855.68
|
| Rate for Payer: United Healthcare All Payer |
$7,201.04
|
|
