|
EXC BEN LESION 3.1-4.0 CM
|
Professional
|
Both
|
$4,207.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.34 |
| Max. Negotiated Rate |
$2,524.20 |
| Rate for Payer: Aetna Commercial |
$252.37
|
| Rate for Payer: Ambetter Exchange |
$171.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.34
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.96
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: Cigna Commercial |
$300.66
|
| Rate for Payer: Healthspan PPO |
$252.29
|
| Rate for Payer: Humana Medicaid |
$116.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$219.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.91
|
| Rate for Payer: Molina Healthcare Passport |
$116.58
|
| Rate for Payer: Multiplan PHCS |
$2,524.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.12
|
| Rate for Payer: UHCCP Medicaid |
$94.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.63
|
|
|
EXC BEN LESION 3.1-4.0 CM(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
761P0055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$273.40 |
| Rate for Payer: Aetna Commercial |
$221.20
|
| Rate for Payer: Ambetter Exchange |
$155.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.40
|
| Rate for Payer: Anthem Medicaid |
$104.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$155.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.86
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$273.40
|
| Rate for Payer: Healthspan PPO |
$229.50
|
| Rate for Payer: Humana Medicaid |
$104.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.31
|
| Rate for Payer: Molina Healthcare Passport |
$104.23
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$202.44
|
| Rate for Payer: UHCCP Medicaid |
$87.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$155.72
|
|
|
EXC BEN LESION 3.1-4.0 CM(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
761P0061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.34 |
| Max. Negotiated Rate |
$300.66 |
| Rate for Payer: Aetna Commercial |
$252.37
|
| Rate for Payer: Ambetter Exchange |
$171.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.34
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.96
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$300.66
|
| Rate for Payer: Healthspan PPO |
$252.29
|
| Rate for Payer: Humana Medicaid |
$116.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$219.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.91
|
| Rate for Payer: Molina Healthcare Passport |
$116.58
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.12
|
| Rate for Payer: UHCCP Medicaid |
$94.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.63
|
|
|
EXC BEN LESION 3.1-4.0 CM(T
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
761T0055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.50 |
| Max. Negotiated Rate |
$3,364.80 |
| Rate for Payer: Aetna Commercial |
$2,698.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.90
|
| Rate for Payer: Cash Price |
$1,752.50
|
| Rate for Payer: Cigna Commercial |
$2,909.15
|
| Rate for Payer: First Health Commercial |
$3,329.75
|
| Rate for Payer: Humana Commercial |
$2,979.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,049.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.45
|
| Rate for Payer: PHCS Commercial |
$3,364.80
|
| Rate for Payer: United Healthcare All Payer |
$3,084.40
|
|
|
EXC BEN LESION 3.1-4.0 CM(T
|
Facility
|
IP
|
$3,707.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
761T0061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,112.10 |
| Max. Negotiated Rate |
$3,558.72 |
| Rate for Payer: Aetna Commercial |
$2,854.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,891.46
|
| Rate for Payer: Cash Price |
$1,853.50
|
| Rate for Payer: Cigna Commercial |
$3,076.81
|
| Rate for Payer: First Health Commercial |
$3,521.65
|
| Rate for Payer: Humana Commercial |
$3,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,039.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,735.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,262.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,780.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,225.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,557.83
|
| Rate for Payer: PHCS Commercial |
$3,558.72
|
| Rate for Payer: United Healthcare All Payer |
$3,262.16
|
|
|
EXC BEN LESION 3.1-4.0 CM(T
|
Facility
|
OP
|
$3,707.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
761T0061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,274.84 |
| Max. Negotiated Rate |
$3,558.72 |
| Rate for Payer: Aetna Commercial |
$2,854.39
|
| Rate for Payer: Anthem Medicaid |
$1,274.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,891.46
|
| 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 |
$1,853.50
|
| Rate for Payer: Cash Price |
$1,853.50
|
| Rate for Payer: Cigna Commercial |
$3,076.81
|
| Rate for Payer: First Health Commercial |
$3,521.65
|
| Rate for Payer: Humana Commercial |
$3,150.95
|
| Rate for Payer: Humana KY Medicaid |
$1,274.84
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,287.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,039.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,735.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,300.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,262.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,780.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,225.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,557.83
|
| Rate for Payer: PHCS Commercial |
$3,558.72
|
| Rate for Payer: United Healthcare All Payer |
$3,262.16
|
|
|
EXC BEN LESION 3.1-4.0 CM(T
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
761T0055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,205.37 |
| Max. Negotiated Rate |
$3,364.80 |
| Rate for Payer: Aetna Commercial |
$2,698.85
|
| Rate for Payer: Anthem Medicaid |
$1,205.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.90
|
| 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 |
$1,752.50
|
| Rate for Payer: Cash Price |
$1,752.50
|
| Rate for Payer: Cigna Commercial |
$2,909.15
|
| Rate for Payer: First Health Commercial |
$3,329.75
|
| Rate for Payer: Humana Commercial |
$2,979.25
|
| Rate for Payer: Humana KY Medicaid |
$1,205.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,049.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.45
|
| Rate for Payer: PHCS Commercial |
$3,364.80
|
| Rate for Payer: United Healthcare All Payer |
$3,084.40
|
|
|
EXC BEN LESION .6-1.0 CM
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,927.68 |
| Rate for Payer: Aetna Commercial |
$1,546.16
|
| Rate for Payer: Anthem Medicaid |
$690.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,666.64
|
| Rate for Payer: First Health Commercial |
$1,907.60
|
| Rate for Payer: Humana Commercial |
$1,706.80
|
| Rate for Payer: Humana KY Medicaid |
$690.55
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,746.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.52
|
| Rate for Payer: PHCS Commercial |
$1,927.68
|
| Rate for Payer: United Healthcare All Payer |
$1,767.04
|
|
|
EXC BEN LESION .6-1.0 CM
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$1,204.80 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Ambetter Exchange |
$98.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.63
|
| Rate for Payer: Anthem Medicaid |
$56.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.69
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$186.50
|
| Rate for Payer: Healthspan PPO |
$155.40
|
| Rate for Payer: Humana Medicaid |
$56.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.82
|
| Rate for Payer: Molina Healthcare Passport |
$56.69
|
| Rate for Payer: Multiplan PHCS |
$1,204.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.58
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.91
|
|
|
EXC BEN LESION .6-1.0 CM
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.40 |
| Max. Negotiated Rate |
$1,927.68 |
| Rate for Payer: Aetna Commercial |
$1,546.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.24
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,666.64
|
| Rate for Payer: First Health Commercial |
$1,907.60
|
| Rate for Payer: Humana Commercial |
$1,706.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,746.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.52
|
| Rate for Payer: PHCS Commercial |
$1,927.68
|
| Rate for Payer: United Healthcare All Payer |
$1,767.04
|
|
|
EXC BEN LESION .6-1.0 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761P0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$186.50 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Ambetter Exchange |
$98.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.63
|
| Rate for Payer: Anthem Medicaid |
$56.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.69
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$186.50
|
| Rate for Payer: Healthspan PPO |
$155.40
|
| Rate for Payer: Humana Medicaid |
$56.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.82
|
| Rate for Payer: Molina Healthcare Passport |
$56.69
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.58
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.91
|
|
|
EXC BEN LESION .6-1.0 CM(T
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761T0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$1,639.68 |
| Rate for Payer: Aetna Commercial |
$1,315.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,332.24
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cigna Commercial |
$1,417.64
|
| Rate for Payer: First Health Commercial |
$1,622.60
|
| Rate for Payer: Humana Commercial |
$1,451.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,400.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,260.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,503.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,281.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.52
|
| Rate for Payer: PHCS Commercial |
$1,639.68
|
| Rate for Payer: United Healthcare All Payer |
$1,503.04
|
|
|
EXC BEN LESION .6-1.0 CM(T
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761T0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,639.68 |
| Rate for Payer: Aetna Commercial |
$1,315.16
|
| Rate for Payer: Anthem Medicaid |
$587.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,332.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cigna Commercial |
$1,417.64
|
| Rate for Payer: First Health Commercial |
$1,622.60
|
| Rate for Payer: Humana Commercial |
$1,451.80
|
| Rate for Payer: Humana KY Medicaid |
$587.38
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$593.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,400.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,260.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,503.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,281.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,485.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.52
|
| Rate for Payer: PHCS Commercial |
$1,639.68
|
| Rate for Payer: United Healthcare All Payer |
$1,503.04
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Facility
|
IP
|
$5,613.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,683.90 |
| Max. Negotiated Rate |
$5,388.48 |
| Rate for Payer: Aetna Commercial |
$4,322.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,378.14
|
| Rate for Payer: Cash Price |
$2,806.50
|
| Rate for Payer: Cigna Commercial |
$4,658.79
|
| Rate for Payer: First Health Commercial |
$5,332.35
|
| Rate for Payer: Humana Commercial |
$4,771.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,490.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,883.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,872.97
|
| Rate for Payer: PHCS Commercial |
$5,388.48
|
| Rate for Payer: United Healthcare All Payer |
$4,939.44
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Professional
|
Both
|
$5,613.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.43 |
| Max. Negotiated Rate |
$3,367.80 |
| Rate for Payer: Aetna Commercial |
$388.18
|
| Rate for Payer: Ambetter Exchange |
$255.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.43
|
| Rate for Payer: Anthem Medicaid |
$165.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.06
|
| Rate for Payer: Cash Price |
$2,806.50
|
| Rate for Payer: Cash Price |
$2,806.50
|
| Rate for Payer: Cigna Commercial |
$358.36
|
| Rate for Payer: Healthspan PPO |
$365.17
|
| Rate for Payer: Humana Medicaid |
$165.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Molina Healthcare Passport |
$165.58
|
| Rate for Payer: Multiplan PHCS |
$3,367.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$331.56
|
| Rate for Payer: UHCCP Medicaid |
$145.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.05
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Facility
|
OP
|
$5,613.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,930.31 |
| Max. Negotiated Rate |
$5,388.48 |
| Rate for Payer: Aetna Commercial |
$4,322.01
|
| Rate for Payer: Anthem Medicaid |
$1,930.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,378.14
|
| 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 |
$2,806.50
|
| Rate for Payer: Cash Price |
$2,806.50
|
| Rate for Payer: Cigna Commercial |
$4,658.79
|
| Rate for Payer: First Health Commercial |
$5,332.35
|
| Rate for Payer: Humana Commercial |
$4,771.05
|
| Rate for Payer: Humana KY Medicaid |
$1,930.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,490.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,883.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,872.97
|
| Rate for Payer: PHCS Commercial |
$5,388.48
|
| Rate for Payer: United Healthcare All Payer |
$4,939.44
|
|
|
EXC BEN LESION OVER 4.0 CM(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761P0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.43 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$388.18
|
| Rate for Payer: Ambetter Exchange |
$255.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.43
|
| Rate for Payer: Anthem Medicaid |
$165.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.06
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$358.36
|
| Rate for Payer: Healthspan PPO |
$365.17
|
| Rate for Payer: Humana Medicaid |
$165.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Molina Healthcare Passport |
$165.58
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$331.56
|
| Rate for Payer: UHCCP Medicaid |
$145.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.05
|
|
|
EXC BEN LESION OVER 4.0 CM(T
|
Facility
|
IP
|
$4,813.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761T0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,443.90 |
| Max. Negotiated Rate |
$4,620.48 |
| Rate for Payer: Aetna Commercial |
$3,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,754.14
|
| Rate for Payer: Cash Price |
$2,406.50
|
| Rate for Payer: Cigna Commercial |
$3,994.79
|
| Rate for Payer: First Health Commercial |
$4,572.35
|
| Rate for Payer: Humana Commercial |
$4,091.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,187.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.97
|
| Rate for Payer: PHCS Commercial |
$4,620.48
|
| Rate for Payer: United Healthcare All Payer |
$4,235.44
|
|
|
EXC BEN LESION OVER 4.0 CM(T
|
Facility
|
OP
|
$4,813.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761T0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,655.19 |
| Max. Negotiated Rate |
$4,620.48 |
| Rate for Payer: Aetna Commercial |
$3,706.01
|
| Rate for Payer: Anthem Medicaid |
$1,655.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,754.14
|
| 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 |
$2,406.50
|
| Rate for Payer: Cash Price |
$2,406.50
|
| Rate for Payer: Cigna Commercial |
$3,994.79
|
| Rate for Payer: First Health Commercial |
$4,572.35
|
| Rate for Payer: Humana Commercial |
$4,091.05
|
| Rate for Payer: Humana KY Medicaid |
$1,655.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,672.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,187.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.97
|
| Rate for Payer: PHCS Commercial |
$4,620.48
|
| Rate for Payer: United Healthcare All Payer |
$4,235.44
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| 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: 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 |
$655.20
|
| 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 BGN LES 1.1-2.0CM S N H FG
|
Professional
|
Both
|
$2,584.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$1,550.40 |
| Rate for Payer: Aetna Commercial |
$186.40
|
| Rate for Payer: Ambetter Exchange |
$127.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$77.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$153.55
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Healthspan PPO |
$186.70
|
| Rate for Payer: Humana Medicaid |
$77.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.38
|
| Rate for Payer: Molina Healthcare Passport |
$77.82
|
| Rate for Payer: Multiplan PHCS |
$1,550.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.96
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| 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 BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,584.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$888.64 |
| Max. Negotiated Rate |
$2,480.64 |
| Rate for Payer: Aetna Commercial |
$1,989.68
|
| Rate for Payer: Anthem Medicaid |
$888.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,015.52
|
| 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 |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cigna Commercial |
$2,144.72
|
| Rate for Payer: First Health Commercial |
$2,454.80
|
| Rate for Payer: Humana Commercial |
$2,196.40
|
| Rate for Payer: Humana KY Medicaid |
$888.64
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$897.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,118.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,906.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$906.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,273.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,938.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,248.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,782.96
|
| Rate for Payer: PHCS Commercial |
$2,480.64
|
| Rate for Payer: United Healthcare All Payer |
$2,273.92
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
761T0059
|
|
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 BGN LES 1.1-2.0CM S N H FG
|
Facility
|
IP
|
$2,584.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$2,480.64 |
| Rate for Payer: Aetna Commercial |
$1,989.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,015.52
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cigna Commercial |
$2,144.72
|
| Rate for Payer: First Health Commercial |
$2,454.80
|
| Rate for Payer: Humana Commercial |
$2,196.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,118.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,906.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$775.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,273.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,938.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,248.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,782.96
|
| Rate for Payer: PHCS Commercial |
$2,480.64
|
| Rate for Payer: United Healthcare All Payer |
$2,273.92
|
|
