|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem Medicaid |
$1,575.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| 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 |
$2,290.00
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Humana KY Medicaid |
$1,575.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,606.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,984.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,160.20
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
EXC MALIG LES 3.1-4.0 CM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761P0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$376.86 |
| Rate for Payer: Aetna Commercial |
$294.45
|
| Rate for Payer: Ambetter Exchange |
$199.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.75
|
| Rate for Payer: Anthem Medicaid |
$150.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$199.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$199.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$239.65
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$376.86
|
| Rate for Payer: Healthspan PPO |
$332.16
|
| Rate for Payer: Humana Medicaid |
$150.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$265.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$199.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.03
|
| Rate for Payer: Molina Healthcare Passport |
$150.03
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.62
|
| Rate for Payer: UHCCP Medicaid |
$116.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$199.71
|
|
|
EXC MALIG LES 3.1-4.0 CM(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761P0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$336.11
|
| Rate for Payer: Ambetter Exchange |
$223.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.88
|
| Rate for Payer: Anthem Medicaid |
$193.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.76
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$307.39
|
| Rate for Payer: Healthspan PPO |
$363.33
|
| Rate for Payer: Humana Medicaid |
$193.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$299.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.91
|
| Rate for Payer: Molina Healthcare Passport |
$193.05
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.07
|
| Rate for Payer: UHCCP Medicaid |
$140.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.13
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761T0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,351.53 |
| Max. Negotiated Rate |
$3,772.80 |
| Rate for Payer: Aetna Commercial |
$3,026.10
|
| Rate for Payer: Anthem Medicaid |
$1,351.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,065.40
|
| 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 |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cigna Commercial |
$3,261.90
|
| Rate for Payer: First Health Commercial |
$3,733.50
|
| Rate for Payer: Humana Commercial |
$3,340.50
|
| Rate for Payer: Humana KY Medicaid |
$1,351.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,365.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,222.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,900.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,458.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,947.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,419.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.70
|
| Rate for Payer: PHCS Commercial |
$3,772.80
|
| Rate for Payer: United Healthcare All Payer |
$3,458.40
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
IP
|
$2,742.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761T0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.60 |
| Max. Negotiated Rate |
$2,632.32 |
| Rate for Payer: Aetna Commercial |
$2,111.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,138.76
|
| Rate for Payer: Cash Price |
$1,371.00
|
| Rate for Payer: Cigna Commercial |
$2,275.86
|
| Rate for Payer: First Health Commercial |
$2,604.90
|
| Rate for Payer: Humana Commercial |
$2,330.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,248.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,023.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,412.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,385.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,891.98
|
| Rate for Payer: PHCS Commercial |
$2,632.32
|
| Rate for Payer: United Healthcare All Payer |
$2,412.96
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761T0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,179.00 |
| Max. Negotiated Rate |
$3,772.80 |
| Rate for Payer: Aetna Commercial |
$3,026.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,065.40
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cigna Commercial |
$3,261.90
|
| Rate for Payer: First Health Commercial |
$3,733.50
|
| Rate for Payer: Humana Commercial |
$3,340.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,222.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,900.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,458.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,947.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,419.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,711.70
|
| Rate for Payer: PHCS Commercial |
$3,772.80
|
| Rate for Payer: United Healthcare All Payer |
$3,458.40
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
OP
|
$2,742.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761T0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,632.32 |
| Rate for Payer: Aetna Commercial |
$2,111.34
|
| Rate for Payer: Anthem Medicaid |
$942.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,138.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,371.00
|
| Rate for Payer: Cash Price |
$1,371.00
|
| Rate for Payer: Cigna Commercial |
$2,275.86
|
| Rate for Payer: First Health Commercial |
$2,604.90
|
| Rate for Payer: Humana Commercial |
$2,330.70
|
| Rate for Payer: Humana KY Medicaid |
$942.97
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$952.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,248.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,023.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$961.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,412.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,385.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,891.98
|
| Rate for Payer: PHCS Commercial |
$2,632.32
|
| Rate for Payer: United Healthcare All Payer |
$2,412.96
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
OP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem Medicaid |
$847.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Humana KY Medicaid |
$847.37
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$864.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,971.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,143.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,700.16
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.50 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
IP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$739.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,971.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,143.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,700.16
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIG LES .6-1.0 CM
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna Commercial |
$203.83
|
| Rate for Payer: Ambetter Exchange |
$138.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$95.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$166.75
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$273.61
|
| Rate for Payer: Healthspan PPO |
$239.59
|
| Rate for Payer: Humana Medicaid |
$95.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$138.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.27
|
| Rate for Payer: Molina Healthcare Passport |
$95.36
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.65
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.96
|
|
|
EXC MALIG LES .6-1.0 CM
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$1,478.40 |
| Rate for Payer: Aetna Commercial |
$206.03
|
| Rate for Payer: Ambetter Exchange |
$140.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.03
|
| Rate for Payer: Anthem Medicaid |
$107.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.30
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$274.75
|
| Rate for Payer: Healthspan PPO |
$241.77
|
| Rate for Payer: Humana Medicaid |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.31
|
| Rate for Payer: Molina Healthcare Passport |
$107.17
|
| Rate for Payer: Multiplan PHCS |
$1,478.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.32
|
| Rate for Payer: UHCCP Medicaid |
$84.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.25
|
|
|
EXC MALIG LES .6-1.0 CM(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761P0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Aetna Commercial |
$206.03
|
| Rate for Payer: Ambetter Exchange |
$140.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.03
|
| Rate for Payer: Anthem Medicaid |
$107.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.30
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$274.75
|
| Rate for Payer: Healthspan PPO |
$241.77
|
| Rate for Payer: Humana Medicaid |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.31
|
| Rate for Payer: Molina Healthcare Passport |
$107.17
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.32
|
| Rate for Payer: UHCCP Medicaid |
$84.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.25
|
|
|
EXC MALIG LES .6-1.0 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761P0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$273.61 |
| Rate for Payer: Aetna Commercial |
$203.83
|
| Rate for Payer: Ambetter Exchange |
$138.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$95.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$166.75
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$273.61
|
| Rate for Payer: Healthspan PPO |
$239.59
|
| Rate for Payer: Humana Medicaid |
$95.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$138.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.27
|
| Rate for Payer: Molina Healthcare Passport |
$95.36
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.65
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.96
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761T0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$1,377.60 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.15
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761T0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$1,377.60 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem Medicaid |
$493.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Humana KY Medicaid |
$493.50
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$498.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$503.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.15
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
OP
|
$2,089.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761T0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem Medicaid |
$718.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Humana KY Medicaid |
$718.41
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$725.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,817.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.41
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
IP
|
$2,089.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761T0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.70 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,817.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.41
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
OP
|
$4,897.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,701.12 |
| Rate for Payer: Aetna Commercial |
$3,770.69
|
| Rate for Payer: Anthem Medicaid |
$1,684.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.66
|
| 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 |
$2,448.50
|
| Rate for Payer: Cash Price |
$2,448.50
|
| Rate for Payer: Cigna Commercial |
$4,064.51
|
| Rate for Payer: First Health Commercial |
$4,652.15
|
| Rate for Payer: Humana Commercial |
$4,162.45
|
| Rate for Payer: Humana KY Medicaid |
$1,684.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,701.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.93
|
| Rate for Payer: PHCS Commercial |
$4,701.12
|
| Rate for Payer: United Healthcare All Payer |
$4,309.36
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
IP
|
$5,830.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,749.00 |
| Max. Negotiated Rate |
$5,596.80 |
| Rate for Payer: Aetna Commercial |
$4,489.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,547.40
|
| Rate for Payer: Cash Price |
$2,915.00
|
| Rate for Payer: Cigna Commercial |
$4,838.90
|
| Rate for Payer: First Health Commercial |
$5,538.50
|
| Rate for Payer: Humana Commercial |
$4,955.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,780.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,302.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,749.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,372.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,072.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,022.70
|
| Rate for Payer: PHCS Commercial |
$5,596.80
|
| Rate for Payer: United Healthcare All Payer |
$5,130.40
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
OP
|
$5,830.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,004.94 |
| Max. Negotiated Rate |
$5,596.80 |
| Rate for Payer: Aetna Commercial |
$4,489.10
|
| Rate for Payer: Anthem Medicaid |
$2,004.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,547.40
|
| 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 |
$2,915.00
|
| Rate for Payer: Cash Price |
$2,915.00
|
| Rate for Payer: Cigna Commercial |
$4,838.90
|
| Rate for Payer: First Health Commercial |
$5,538.50
|
| Rate for Payer: Humana Commercial |
$4,955.50
|
| Rate for Payer: Humana KY Medicaid |
$2,004.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,025.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,780.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,302.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,045.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,372.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,072.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,022.70
|
| Rate for Payer: PHCS Commercial |
$5,596.80
|
| Rate for Payer: United Healthcare All Payer |
$5,130.40
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Professional
|
Both
|
$5,830.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$3,498.00 |
| Rate for Payer: Aetna Commercial |
$424.81
|
| Rate for Payer: Ambetter Exchange |
$274.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.41
|
| Rate for Payer: Anthem Medicaid |
$227.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$274.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$274.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.98
|
| Rate for Payer: Cash Price |
$2,915.00
|
| Rate for Payer: Cash Price |
$2,915.00
|
| Rate for Payer: Cigna Commercial |
$527.28
|
| Rate for Payer: Healthspan PPO |
$446.23
|
| Rate for Payer: Humana Medicaid |
$227.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$274.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.64
|
| Rate for Payer: Molina Healthcare Passport |
$227.10
|
| Rate for Payer: Multiplan PHCS |
$3,498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$356.39
|
| Rate for Payer: UHCCP Medicaid |
$169.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$274.15
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Professional
|
Both
|
$4,897.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$2,938.20 |
| Rate for Payer: Aetna Commercial |
$439.41
|
| Rate for Payer: Ambetter Exchange |
$297.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.27
|
| Rate for Payer: Anthem Medicaid |
$194.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$357.30
|
| Rate for Payer: Cash Price |
$2,448.50
|
| Rate for Payer: Cash Price |
$2,448.50
|
| Rate for Payer: Cigna Commercial |
$390.19
|
| Rate for Payer: Healthspan PPO |
$471.17
|
| Rate for Payer: Humana Medicaid |
$194.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$394.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$297.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.39
|
| Rate for Payer: Molina Healthcare Passport |
$194.50
|
| Rate for Payer: Multiplan PHCS |
$2,938.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$387.07
|
| Rate for Payer: UHCCP Medicaid |
$169.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.75
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
IP
|
$4,897.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,469.10 |
| Max. Negotiated Rate |
$4,701.12 |
| Rate for Payer: Aetna Commercial |
$3,770.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,819.66
|
| Rate for Payer: Cash Price |
$2,448.50
|
| Rate for Payer: Cigna Commercial |
$4,064.51
|
| Rate for Payer: First Health Commercial |
$4,652.15
|
| Rate for Payer: Humana Commercial |
$4,162.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,015.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,613.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,309.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,260.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,378.93
|
| Rate for Payer: PHCS Commercial |
$4,701.12
|
| Rate for Payer: United Healthcare All Payer |
$4,309.36
|
|
