|
EXC BACK LES SC < 3 CM(T
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
761T0412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$751.08 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem Medicaid |
$751.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Humana KY Medicaid |
$751.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXC BACK LES SC = 3 CM(T
|
Facility
|
IP
|
$6,168.00
|
|
|
Service Code
|
HCPCS 21931
|
| Hospital Charge Code |
761T0413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,850.40 |
| Max. Negotiated Rate |
$5,921.28 |
| Rate for Payer: Aetna Commercial |
$4,749.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,811.04
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cigna Commercial |
$5,119.44
|
| Rate for Payer: First Health Commercial |
$5,859.60
|
| Rate for Payer: Humana Commercial |
$5,242.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,057.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,551.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,850.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,427.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,626.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,366.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,255.92
|
| Rate for Payer: PHCS Commercial |
$5,921.28
|
| Rate for Payer: United Healthcare All Payer |
$5,427.84
|
|
|
EXC BACK LES SC = 3 CM(T
|
Facility
|
OP
|
$6,168.00
|
|
|
Service Code
|
HCPCS 21931
|
| Hospital Charge Code |
761T0413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,921.28 |
| Rate for Payer: Aetna Commercial |
$4,749.36
|
| Rate for Payer: Anthem Medicaid |
$2,121.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,811.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cash Price |
$3,084.00
|
| Rate for Payer: Cigna Commercial |
$5,119.44
|
| Rate for Payer: First Health Commercial |
$5,859.60
|
| Rate for Payer: Humana Commercial |
$5,242.80
|
| Rate for Payer: Humana KY Medicaid |
$2,121.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,142.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,057.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,551.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,163.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,427.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,626.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,366.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,255.92
|
| Rate for Payer: PHCS Commercial |
$5,921.28
|
| Rate for Payer: United Healthcare All Payer |
$5,427.84
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Professional
|
Both
|
$7,303.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
76100414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.30 |
| Max. Negotiated Rate |
$4,381.80 |
| Rate for Payer: Aetna Commercial |
$1,040.77
|
| Rate for Payer: Ambetter Exchange |
$634.42
|
| Rate for Payer: Anthem Medicaid |
$488.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$761.30
|
| Rate for Payer: Cash Price |
$3,651.50
|
| Rate for Payer: Cash Price |
$3,651.50
|
| Rate for Payer: Cigna Commercial |
$1,183.46
|
| Rate for Payer: Healthspan PPO |
$742.69
|
| Rate for Payer: Humana Medicaid |
$488.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$852.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$634.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.07
|
| Rate for Payer: Molina Healthcare Passport |
$488.30
|
| Rate for Payer: Multiplan PHCS |
$4,381.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$824.75
|
| Rate for Payer: UHCCP Medicaid |
$2,556.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.42
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Facility
|
IP
|
$7,303.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
76100414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,190.90 |
| Max. Negotiated Rate |
$7,010.88 |
| Rate for Payer: Aetna Commercial |
$5,623.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,696.34
|
| Rate for Payer: Cash Price |
$3,651.50
|
| Rate for Payer: Cigna Commercial |
$6,061.49
|
| Rate for Payer: First Health Commercial |
$6,937.85
|
| Rate for Payer: Humana Commercial |
$6,207.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,988.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,389.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,190.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,426.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,477.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,353.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,039.07
|
| Rate for Payer: PHCS Commercial |
$7,010.88
|
| Rate for Payer: United Healthcare All Payer |
$6,426.64
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Facility
|
OP
|
$7,303.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
76100414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,511.50 |
| Max. Negotiated Rate |
$7,010.88 |
| Rate for Payer: Aetna Commercial |
$5,623.31
|
| Rate for Payer: Anthem Medicaid |
$2,511.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,696.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,651.50
|
| Rate for Payer: Cash Price |
$3,651.50
|
| Rate for Payer: Cigna Commercial |
$6,061.49
|
| Rate for Payer: First Health Commercial |
$6,937.85
|
| Rate for Payer: Humana Commercial |
$6,207.55
|
| Rate for Payer: Humana KY Medicaid |
$2,511.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,537.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,988.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,389.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,561.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,426.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,477.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,353.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,039.07
|
| Rate for Payer: PHCS Commercial |
$7,010.88
|
| Rate for Payer: United Healthcare All Payer |
$6,426.64
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$8,172.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,451.60 |
| Max. Negotiated Rate |
$7,845.12 |
| Rate for Payer: Aetna Commercial |
$6,292.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,374.16
|
| Rate for Payer: Cash Price |
$4,086.00
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: First Health Commercial |
$7,763.40
|
| Rate for Payer: Humana Commercial |
$6,946.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,701.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,191.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.68
|
| Rate for Payer: PHCS Commercial |
$7,845.12
|
| Rate for Payer: United Healthcare All Payer |
$7,191.36
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Professional
|
Both
|
$8,172.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.01 |
| Max. Negotiated Rate |
$4,903.20 |
| Rate for Payer: Aetna Commercial |
$1,149.42
|
| Rate for Payer: Ambetter Exchange |
$703.52
|
| Rate for Payer: Anthem Medicaid |
$539.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$703.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$844.22
|
| Rate for Payer: Cash Price |
$4,086.00
|
| Rate for Payer: Cash Price |
$4,086.00
|
| Rate for Payer: Cigna Commercial |
$1,306.12
|
| Rate for Payer: Healthspan PPO |
$820.63
|
| Rate for Payer: Humana Medicaid |
$539.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$703.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.79
|
| Rate for Payer: Molina Healthcare Passport |
$539.01
|
| Rate for Payer: Multiplan PHCS |
$4,903.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$914.58
|
| Rate for Payer: UHCCP Medicaid |
$2,860.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$703.52
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$8,172.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,845.12 |
| Rate for Payer: Aetna Commercial |
$6,292.44
|
| Rate for Payer: Anthem Medicaid |
$2,810.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,374.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$4,086.00
|
| Rate for Payer: Cash Price |
$4,086.00
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: First Health Commercial |
$7,763.40
|
| Rate for Payer: Humana Commercial |
$6,946.20
|
| Rate for Payer: Humana KY Medicaid |
$2,810.35
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,838.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,701.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,866.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,191.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.68
|
| Rate for Payer: PHCS Commercial |
$7,845.12
|
| Rate for Payer: United Healthcare All Payer |
$7,191.36
|
|
|
EXC BACK TUM DEEP < 5 CM(P
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
761P0414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.95 |
| Max. Negotiated Rate |
$1,183.46 |
| Rate for Payer: Aetna Commercial |
$1,040.77
|
| Rate for Payer: Ambetter Exchange |
$634.42
|
| Rate for Payer: Anthem Medicaid |
$488.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$761.30
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cigna Commercial |
$1,183.46
|
| Rate for Payer: Healthspan PPO |
$742.69
|
| Rate for Payer: Humana Medicaid |
$488.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$852.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$634.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.07
|
| Rate for Payer: Molina Healthcare Passport |
$488.30
|
| Rate for Payer: Multiplan PHCS |
$646.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$824.75
|
| Rate for Payer: UHCCP Medicaid |
$376.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.42
|
|
|
EXC BACK TUM DEEP 5 CM/>(P
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
761P0415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,306.12 |
| Rate for Payer: Aetna Commercial |
$1,149.42
|
| Rate for Payer: Ambetter Exchange |
$703.52
|
| Rate for Payer: Anthem Medicaid |
$539.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$703.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$844.22
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,306.12
|
| Rate for Payer: Healthspan PPO |
$820.63
|
| Rate for Payer: Humana Medicaid |
$539.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$703.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.79
|
| Rate for Payer: Molina Healthcare Passport |
$539.01
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$914.58
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$703.52
|
|
|
EXC BACK TUM DEEP < 5 CM(T
|
Facility
|
IP
|
$6,226.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
761T0414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,867.80 |
| Max. Negotiated Rate |
$5,976.96 |
| Rate for Payer: Aetna Commercial |
$4,794.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,856.28
|
| Rate for Payer: Cash Price |
$3,113.00
|
| Rate for Payer: Cigna Commercial |
$5,167.58
|
| Rate for Payer: First Health Commercial |
$5,914.70
|
| Rate for Payer: Humana Commercial |
$5,292.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,105.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,594.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,867.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,478.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,980.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,416.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,295.94
|
| Rate for Payer: PHCS Commercial |
$5,976.96
|
| Rate for Payer: United Healthcare All Payer |
$5,478.88
|
|
|
EXC BACK TUM DEEP < 5 CM(T
|
Facility
|
OP
|
$6,226.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
761T0414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,141.12 |
| Max. Negotiated Rate |
$5,976.96 |
| Rate for Payer: Aetna Commercial |
$4,794.02
|
| Rate for Payer: Anthem Medicaid |
$2,141.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,856.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,113.00
|
| Rate for Payer: Cash Price |
$3,113.00
|
| Rate for Payer: Cigna Commercial |
$5,167.58
|
| Rate for Payer: First Health Commercial |
$5,914.70
|
| Rate for Payer: Humana Commercial |
$5,292.10
|
| Rate for Payer: Humana KY Medicaid |
$2,141.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,162.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,105.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,594.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,184.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,478.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,980.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,416.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,295.94
|
| Rate for Payer: PHCS Commercial |
$5,976.96
|
| Rate for Payer: United Healthcare All Payer |
$5,478.88
|
|
|
EXC BACK TUM DEEP 5 CM/>(T
|
Facility
|
IP
|
$7,002.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
761T0415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,100.60 |
| Max. Negotiated Rate |
$6,721.92 |
| Rate for Payer: Aetna Commercial |
$5,391.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,461.56
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$5,811.66
|
| Rate for Payer: First Health Commercial |
$6,651.90
|
| Rate for Payer: Humana Commercial |
$5,951.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,741.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,167.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,161.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,251.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,091.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,831.38
|
| Rate for Payer: PHCS Commercial |
$6,721.92
|
| Rate for Payer: United Healthcare All Payer |
$6,161.76
|
|
|
EXC BACK TUM DEEP 5 CM/>(T
|
Facility
|
OP
|
$7,002.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
761T0415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,407.99 |
| Max. Negotiated Rate |
$6,721.92 |
| Rate for Payer: Aetna Commercial |
$5,391.54
|
| Rate for Payer: Anthem Medicaid |
$2,407.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,461.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$5,811.66
|
| Rate for Payer: First Health Commercial |
$6,651.90
|
| Rate for Payer: Humana Commercial |
$5,951.70
|
| Rate for Payer: Humana KY Medicaid |
$2,407.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,432.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,741.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,167.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,456.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,161.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,251.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,091.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,831.38
|
| Rate for Payer: PHCS Commercial |
$6,721.92
|
| Rate for Payer: United Healthcare All Payer |
$6,161.76
|
|
|
EXC BENIGN 2.1 TO 3.0 CM
|
Facility
|
IP
|
$3,484.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$3,344.64 |
| Rate for Payer: Aetna Commercial |
$2,682.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,717.52
|
| Rate for Payer: Cash Price |
$1,742.00
|
| Rate for Payer: Cigna Commercial |
$2,891.72
|
| Rate for Payer: First Health Commercial |
$3,309.80
|
| Rate for Payer: Humana Commercial |
$2,961.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,571.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,031.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,403.96
|
| Rate for Payer: PHCS Commercial |
$3,344.64
|
| Rate for Payer: United Healthcare All Payer |
$3,065.92
|
|
|
EXC BENIGN 2.1 TO 3.0 CM
|
Professional
|
Both
|
$3,484.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$2,090.40 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: Ambetter Exchange |
$168.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.56
|
| Rate for Payer: Anthem Medicaid |
$114.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.37
|
| Rate for Payer: Cash Price |
$1,742.00
|
| Rate for Payer: Cash Price |
$1,742.00
|
| Rate for Payer: Cigna Commercial |
$295.17
|
| Rate for Payer: Healthspan PPO |
$242.83
|
| Rate for Payer: Humana Medicaid |
$114.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.41
|
| Rate for Payer: Molina Healthcare Passport |
$114.13
|
| Rate for Payer: Multiplan PHCS |
$2,090.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.23
|
| Rate for Payer: UHCCP Medicaid |
$96.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.64
|
|
|
EXC BENIGN 2.1 TO 3.0 CM
|
Facility
|
OP
|
$3,484.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.15 |
| Max. Negotiated Rate |
$3,344.64 |
| Rate for Payer: Aetna Commercial |
$2,682.68
|
| Rate for Payer: Anthem Medicaid |
$1,198.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,717.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,742.00
|
| Rate for Payer: Cash Price |
$1,742.00
|
| Rate for Payer: Cigna Commercial |
$2,891.72
|
| Rate for Payer: First Health Commercial |
$3,309.80
|
| Rate for Payer: Humana Commercial |
$2,961.40
|
| Rate for Payer: Humana KY Medicaid |
$1,198.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,571.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,222.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,031.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,403.96
|
| Rate for Payer: PHCS Commercial |
$3,344.64
|
| Rate for Payer: United Healthcare All Payer |
$3,065.92
|
|
|
EXC BENIGN 2.1 TO 3.0 CM(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
761P0066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: Ambetter Exchange |
$168.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.56
|
| Rate for Payer: Anthem Medicaid |
$114.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.37
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$295.17
|
| Rate for Payer: Healthspan PPO |
$242.83
|
| Rate for Payer: Humana Medicaid |
$114.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.41
|
| Rate for Payer: Molina Healthcare Passport |
$114.13
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.23
|
| Rate for Payer: UHCCP Medicaid |
$96.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.64
|
|
|
EXC BENIGN 2.1 TO 3.0 CM(T
|
Facility
|
OP
|
$2,984.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
761T0066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,026.20 |
| Max. Negotiated Rate |
$2,864.64 |
| Rate for Payer: Aetna Commercial |
$2,297.68
|
| Rate for Payer: Anthem Medicaid |
$1,026.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cigna Commercial |
$2,476.72
|
| Rate for Payer: First Health Commercial |
$2,834.80
|
| Rate for Payer: Humana Commercial |
$2,536.40
|
| Rate for Payer: Humana KY Medicaid |
$1,026.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,036.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,202.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,046.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,625.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,238.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,596.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.96
|
| Rate for Payer: PHCS Commercial |
$2,864.64
|
| Rate for Payer: United Healthcare All Payer |
$2,625.92
|
|
|
EXC BENIGN 2.1 TO 3.0 CM(T
|
Facility
|
IP
|
$2,984.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
761T0066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$2,864.64 |
| Rate for Payer: Aetna Commercial |
$2,297.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.52
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cigna Commercial |
$2,476.72
|
| Rate for Payer: First Health Commercial |
$2,834.80
|
| Rate for Payer: Humana Commercial |
$2,536.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,202.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$895.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,625.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,238.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,596.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.96
|
| Rate for Payer: PHCS Commercial |
$2,864.64
|
| Rate for Payer: United Healthcare All Payer |
$2,625.92
|
|
|
EXC BENIGN LESION 2.1-3.0 CM
|
Facility
|
OP
|
$4,003.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.63 |
| Max. Negotiated Rate |
$3,842.88 |
| Rate for Payer: Aetna Commercial |
$3,082.31
|
| Rate for Payer: Anthem Medicaid |
$1,376.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,122.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,001.50
|
| Rate for Payer: Cash Price |
$2,001.50
|
| Rate for Payer: Cigna Commercial |
$3,322.49
|
| Rate for Payer: First Health Commercial |
$3,802.85
|
| Rate for Payer: Humana Commercial |
$3,402.55
|
| Rate for Payer: Humana KY Medicaid |
$1,376.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,282.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,954.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,404.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,522.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,482.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,762.07
|
| Rate for Payer: PHCS Commercial |
$3,842.88
|
| Rate for Payer: United Healthcare All Payer |
$3,522.64
|
|
|
EXC BENIGN LESION 2.1-3.0 CM
|
Professional
|
Both
|
$4,003.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$2,401.80 |
| Rate for Payer: Aetna Commercial |
$218.13
|
| Rate for Payer: Ambetter Exchange |
$148.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.90
|
| Rate for Payer: Anthem Medicaid |
$100.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$178.52
|
| Rate for Payer: Cash Price |
$2,001.50
|
| Rate for Payer: Cash Price |
$2,001.50
|
| Rate for Payer: Cigna Commercial |
$262.75
|
| Rate for Payer: Healthspan PPO |
$218.07
|
| Rate for Payer: Humana Medicaid |
$100.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.01
|
| Rate for Payer: Molina Healthcare Passport |
$100.99
|
| Rate for Payer: Multiplan PHCS |
$2,401.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$193.40
|
| Rate for Payer: UHCCP Medicaid |
$82.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.77
|
|
|
EXC BENIGN LESION 2.1-3.0 CM
|
Facility
|
IP
|
$4,003.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.90 |
| Max. Negotiated Rate |
$3,842.88 |
| Rate for Payer: Aetna Commercial |
$3,082.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,122.34
|
| Rate for Payer: Cash Price |
$2,001.50
|
| Rate for Payer: Cigna Commercial |
$3,322.49
|
| Rate for Payer: First Health Commercial |
$3,802.85
|
| Rate for Payer: Humana Commercial |
$3,402.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,282.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,954.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,522.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,482.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,762.07
|
| Rate for Payer: PHCS Commercial |
$3,842.88
|
| Rate for Payer: United Healthcare All Payer |
$3,522.64
|
|
|
EXC BENIGN LESION 2.1-3.0 CM(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
761P0060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$218.13
|
| Rate for Payer: Ambetter Exchange |
$148.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.90
|
| Rate for Payer: Anthem Medicaid |
$100.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$178.52
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$262.75
|
| Rate for Payer: Healthspan PPO |
$218.07
|
| Rate for Payer: Humana Medicaid |
$100.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.01
|
| Rate for Payer: Molina Healthcare Passport |
$100.99
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$193.40
|
| Rate for Payer: UHCCP Medicaid |
$82.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.77
|
|
