|
CLTX PRX HUM FX W/O MANIP(T
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761T0478
|
|
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
|
|
|
CLTX PRX HUM FX W/O MANIP(T
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761T0478
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
45000126
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
OP
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,011.41 |
| Max. Negotiated Rate |
$2,823.36 |
| Rate for Payer: Aetna Commercial |
$2,264.57
|
| Rate for Payer: Anthem Medicaid |
$1,011.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.98
|
| 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 |
$1,470.50
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$2,441.03
|
| Rate for Payer: First Health Commercial |
$2,793.95
|
| Rate for Payer: Humana Commercial |
$2,499.85
|
| Rate for Payer: Humana KY Medicaid |
$1,011.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.29
|
| Rate for Payer: PHCS Commercial |
$2,823.36
|
| Rate for Payer: United Healthcare All Payer |
$2,588.08
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
IP
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$882.30 |
| Max. Negotiated Rate |
$2,823.36 |
| Rate for Payer: Aetna Commercial |
$2,264.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.98
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$2,441.03
|
| Rate for Payer: First Health Commercial |
$2,793.95
|
| Rate for Payer: Humana Commercial |
$2,499.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.29
|
| Rate for Payer: PHCS Commercial |
$2,823.36
|
| Rate for Payer: United Healthcare All Payer |
$2,588.08
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
45000126
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Professional
|
Both
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$1,764.60 |
| Rate for Payer: Aetna Commercial |
$549.83
|
| Rate for Payer: Ambetter Exchange |
$391.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.22
|
| Rate for Payer: Anthem Medicaid |
$214.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$470.11
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$539.24
|
| Rate for Payer: Humana Medicaid |
$214.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.31
|
| Rate for Payer: Molina Healthcare Passport |
$214.03
|
| Rate for Payer: Multiplan PHCS |
$1,764.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.29
|
| Rate for Payer: UHCCP Medicaid |
$228.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.76
|
|
|
CL TX RAD HD/NECK FX W/MANIP(P
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761P0558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$606.79 |
| Rate for Payer: Aetna Commercial |
$549.83
|
| Rate for Payer: Ambetter Exchange |
$391.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.22
|
| Rate for Payer: Anthem Medicaid |
$214.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$470.11
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$539.24
|
| Rate for Payer: Humana Medicaid |
$214.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.31
|
| Rate for Payer: Molina Healthcare Passport |
$214.03
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.29
|
| Rate for Payer: UHCCP Medicaid |
$228.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.76
|
|
|
CL TX RAD HD/NECK FX W/MANIP(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761T0558
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761T0558
|
|
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
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
OP
|
$1,548.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,486.08 |
| Rate for Payer: Aetna Commercial |
$1,191.96
|
| Rate for Payer: Anthem Medicaid |
$532.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$1,284.84
|
| Rate for Payer: First Health Commercial |
$1,470.60
|
| Rate for Payer: Humana Commercial |
$1,315.80
|
| Rate for Payer: Humana KY Medicaid |
$532.36
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$537.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,269.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,362.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,346.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.12
|
| Rate for Payer: PHCS Commercial |
$1,486.08
|
| Rate for Payer: United Healthcare All Payer |
$1,362.24
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761T0557
|
|
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
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Aetna Commercial |
$310.43
|
| Rate for Payer: Ambetter Exchange |
$240.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.25
|
| Rate for Payer: Anthem Medicaid |
$127.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$240.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.54
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$385.92
|
| Rate for Payer: Healthspan PPO |
$308.81
|
| Rate for Payer: Humana Medicaid |
$127.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$240.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.90
|
| Rate for Payer: Molina Healthcare Passport |
$127.35
|
| Rate for Payer: Multiplan PHCS |
$928.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.58
|
| Rate for Payer: UHCCP Medicaid |
$136.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.45
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
IP
|
$1,548.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,486.08 |
| Rate for Payer: Aetna Commercial |
$1,191.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.44
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$1,284.84
|
| Rate for Payer: First Health Commercial |
$1,470.60
|
| Rate for Payer: Humana Commercial |
$1,315.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,269.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,362.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,346.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.12
|
| Rate for Payer: PHCS Commercial |
$1,486.08
|
| Rate for Payer: United Healthcare All Payer |
$1,362.24
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761P0557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$310.43
|
| Rate for Payer: Ambetter Exchange |
$240.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.25
|
| Rate for Payer: Anthem Medicaid |
$127.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$240.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.54
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$385.92
|
| Rate for Payer: Healthspan PPO |
$308.81
|
| Rate for Payer: Humana Medicaid |
$127.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$240.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.90
|
| Rate for Payer: Molina Healthcare Passport |
$127.35
|
| Rate for Payer: Multiplan PHCS |
$353.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.58
|
| Rate for Payer: UHCCP Medicaid |
$136.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.45
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761T0557
|
|
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
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
IP
|
$3,770.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,131.00 |
| Max. Negotiated Rate |
$3,619.20 |
| Rate for Payer: Aetna Commercial |
$2,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,940.60
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,129.10
|
| Rate for Payer: First Health Commercial |
$3,581.50
|
| Rate for Payer: Humana Commercial |
$3,204.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,091.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,782.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,317.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,827.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,279.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,601.30
|
| Rate for Payer: PHCS Commercial |
$3,619.20
|
| Rate for Payer: United Healthcare All Payer |
$3,317.60
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,296.50 |
| Max. Negotiated Rate |
$3,619.20 |
| Rate for Payer: Aetna Commercial |
$2,902.90
|
| Rate for Payer: Anthem Medicaid |
$1,296.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,940.60
|
| 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 |
$1,885.00
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,129.10
|
| Rate for Payer: First Health Commercial |
$3,581.50
|
| Rate for Payer: Humana Commercial |
$3,204.50
|
| Rate for Payer: Humana KY Medicaid |
$1,296.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,091.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,782.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,322.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,317.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,827.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,279.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,601.30
|
| Rate for Payer: PHCS Commercial |
$3,619.20
|
| Rate for Payer: United Healthcare All Payer |
$3,317.60
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
OP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
45000130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$866.63 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem Medicaid |
$866.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Humana KY Medicaid |
$866.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$875.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$884.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Professional
|
Both
|
$3,770.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Aetna Commercial |
$670.39
|
| Rate for Payer: Ambetter Exchange |
$448.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$287.20
|
| Rate for Payer: Anthem Medicaid |
$297.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$537.78
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$734.25
|
| Rate for Payer: Healthspan PPO |
$657.65
|
| Rate for Payer: Humana Medicaid |
$297.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$575.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.17
|
| Rate for Payer: Molina Healthcare Passport |
$297.23
|
| Rate for Payer: Multiplan PHCS |
$2,262.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$582.60
|
| Rate for Payer: UHCCP Medicaid |
$301.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.15
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
IP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
45000130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
761P0627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$670.39
|
| Rate for Payer: Ambetter Exchange |
$448.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$287.20
|
| Rate for Payer: Anthem Medicaid |
$297.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$537.78
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$734.25
|
| Rate for Payer: Healthspan PPO |
$657.65
|
| Rate for Payer: Humana Medicaid |
$297.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$575.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.17
|
| Rate for Payer: Molina Healthcare Passport |
$297.23
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$582.60
|
| Rate for Payer: UHCCP Medicaid |
$301.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.15
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN(T
|
Facility
|
IP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
761T0627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN(T
|
Facility
|
OP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
761T0627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.63 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem Medicaid |
$866.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Humana KY Medicaid |
$866.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$875.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$884.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
CLTX RAD&ULN SHAFT FX W/O MAN
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
76100626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,525.44 |
| Rate for Payer: Aetna Commercial |
$1,223.53
|
| Rate for Payer: Anthem Medicaid |
$546.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,239.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cigna Commercial |
$1,318.87
|
| Rate for Payer: First Health Commercial |
$1,509.55
|
| Rate for Payer: Humana Commercial |
$1,350.65
|
| Rate for Payer: Humana KY Medicaid |
$546.46
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$552.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,302.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,172.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,398.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,382.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,096.41
|
| Rate for Payer: PHCS Commercial |
$1,525.44
|
| Rate for Payer: United Healthcare All Payer |
$1,398.32
|
|
