|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
45000166
|
|
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
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$628.31
|
| Rate for Payer: Ambetter Exchange |
$422.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.63
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$422.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$507.14
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$694.54
|
| Rate for Payer: Healthspan PPO |
$611.29
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$422.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$422.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.41
|
| Rate for Payer: UHCCP Medicaid |
$258.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$422.62
|
|
|
CLTX MED ANKLE FX W/MNPJ(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
761P0929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$628.31
|
| Rate for Payer: Ambetter Exchange |
$422.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.63
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$422.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$507.14
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$694.54
|
| Rate for Payer: Healthspan PPO |
$611.29
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$422.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$422.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.41
|
| Rate for Payer: UHCCP Medicaid |
$258.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$422.62
|
|
|
CLTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$407.36
|
| Rate for Payer: Ambetter Exchange |
$298.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.88
|
| Rate for Payer: Anthem Medicaid |
$160.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.25
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$501.77
|
| Rate for Payer: Healthspan PPO |
$403.40
|
| Rate for Payer: Humana Medicaid |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.86
|
| Rate for Payer: Molina Healthcare Passport |
$160.65
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.10
|
| Rate for Payer: UHCCP Medicaid |
$167.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.54
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
CLTX MEDIAL ANKLE FX(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
761P0928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$501.77 |
| Rate for Payer: Aetna Commercial |
$407.36
|
| Rate for Payer: Ambetter Exchange |
$298.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.88
|
| Rate for Payer: Anthem Medicaid |
$160.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$501.77
|
| Rate for Payer: Healthspan PPO |
$403.40
|
| Rate for Payer: Humana Medicaid |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.86
|
| Rate for Payer: Molina Healthcare Passport |
$160.65
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.10
|
| Rate for Payer: UHCCP Medicaid |
$167.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.54
|
|
|
CLTX MEDIAL ANKLE FX(T
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
761T0928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.74 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX MEDIAL ANKLE FX(T
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
761T0928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
45000139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.96 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem Medicaid |
$117.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Humana KY Medicaid |
$117.96
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$119.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$274.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.67
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
45000139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$274.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.67
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
CLTX METACARPAL FX W/MANIP
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$483.68 |
| Rate for Payer: Aetna Commercial |
$393.45
|
| Rate for Payer: Ambetter Exchange |
$288.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.08
|
| Rate for Payer: Anthem Medicaid |
$148.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$288.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$346.06
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$483.68
|
| Rate for Payer: Healthspan PPO |
$387.89
|
| Rate for Payer: Humana Medicaid |
$148.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$346.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$288.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.49
|
| Rate for Payer: Molina Healthcare Passport |
$148.52
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.89
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$288.38
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
CLTX METACARPAL FX W/MANIP(P
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
761P0722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$483.68 |
| Rate for Payer: Aetna Commercial |
$393.45
|
| Rate for Payer: Ambetter Exchange |
$288.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.08
|
| Rate for Payer: Anthem Medicaid |
$148.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$288.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$346.06
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$483.68
|
| Rate for Payer: Healthspan PPO |
$387.89
|
| Rate for Payer: Humana Medicaid |
$148.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$346.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$288.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.49
|
| Rate for Payer: Molina Healthcare Passport |
$148.52
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.89
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$288.38
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$1,734.60 |
| Rate for Payer: Aetna Commercial |
$790.98
|
| Rate for Payer: Ambetter Exchange |
$564.67
|
| Rate for Payer: Anthem Medicaid |
$309.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.60
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$870.79
|
| Rate for Payer: Healthspan PPO |
$716.46
|
| Rate for Payer: Humana Medicaid |
$309.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$564.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.68
|
| Rate for Payer: Molina Healthcare Passport |
$309.49
|
| Rate for Payer: Multiplan PHCS |
$1,734.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$734.07
|
| Rate for Payer: UHCCP Medicaid |
$1,011.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.67
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.30 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,515.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,994.79
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761P0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$870.79 |
| Rate for Payer: Aetna Commercial |
$790.98
|
| Rate for Payer: Ambetter Exchange |
$564.67
|
| Rate for Payer: Anthem Medicaid |
$309.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.60
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$870.79
|
| Rate for Payer: Healthspan PPO |
$716.46
|
| Rate for Payer: Humana Medicaid |
$309.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$564.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.68
|
| Rate for Payer: Molina Healthcare Passport |
$309.49
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$734.07
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.67
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761T0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.30 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761T0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.51 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| 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 |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.21 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem Medicaid |
$994.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| 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 |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Humana KY Medicaid |
$994.21
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,004.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,014.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,515.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,994.79
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
761T0932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.10 |
| Max. Negotiated Rate |
$1,917.12 |
| Rate for Payer: Aetna Commercial |
$1,537.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.66
|
| Rate for Payer: Cash Price |
$998.50
|
| Rate for Payer: Cigna Commercial |
$1,657.51
|
| Rate for Payer: First Health Commercial |
$1,897.15
|
| Rate for Payer: Humana Commercial |
$1,697.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.93
|
| Rate for Payer: PHCS Commercial |
$1,917.12
|
| Rate for Payer: United Healthcare All Payer |
$1,757.36
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$906.86 |
| Max. Negotiated Rate |
$2,531.52 |
| Rate for Payer: Aetna Commercial |
$2,030.49
|
| Rate for Payer: Anthem Medicaid |
$906.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.86
|
| 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 |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,188.71
|
| Rate for Payer: First Health Commercial |
$2,505.15
|
| Rate for Payer: Humana Commercial |
$2,241.45
|
| Rate for Payer: Humana KY Medicaid |
$906.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$916.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,162.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,946.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$925.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,320.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.53
|
| Rate for Payer: PHCS Commercial |
$2,531.52
|
| Rate for Payer: United Healthcare All Payer |
$2,320.56
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
761T0932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,537.69
|
| Rate for Payer: Anthem Medicaid |
$686.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.66
|
| 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 |
$998.50
|
| Rate for Payer: Cash Price |
$998.50
|
| Rate for Payer: Cigna Commercial |
$1,657.51
|
| Rate for Payer: First Health Commercial |
$1,897.15
|
| Rate for Payer: Humana Commercial |
$1,697.45
|
| Rate for Payer: Humana KY Medicaid |
$686.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$693.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.93
|
| Rate for Payer: PHCS Commercial |
$1,917.12
|
| Rate for Payer: United Healthcare All Payer |
$1,757.36
|
|
