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Service Code HCPCS 29875
Hospital Charge Code 76101097
Hospital Revenue Code 761
Min. Negotiated Rate $431.23
Max. Negotiated Rate $1,877.00
Rate for Payer: Aetna Commercial $724.11
Rate for Payer: Anthem Medicaid $431.23
Rate for Payer: Buckeye Medicare Advantage $1,877.00
Rate for Payer: Cash Price $938.50
Rate for Payer: Cash Price $938.50
Rate for Payer: Cigna Commercial $801.91
Rate for Payer: Healthspan PPO $655.89
Rate for Payer: Humana Medicaid $431.23
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $612.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $439.85
Rate for Payer: Molina Healthcare Passport $431.23
Rate for Payer: Multiplan PHCS $1,126.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,313.90
Rate for Payer: UHCCP Medicaid $656.95
Rate for Payer: Wellcare CHIP/Medicaid $435.54
Service Code HCPCS 29873
Hospital Charge Code 76101095
Hospital Revenue Code 761
Min. Negotiated Rate $107.90
Max. Negotiated Rate $796.80
Rate for Payer: Aetna Commercial $639.10
Rate for Payer: Anthem POS/PPO/Traditional $647.40
Rate for Payer: Cash Price $415.00
Rate for Payer: Cigna Commercial $688.90
Rate for Payer: First Health Commercial $788.50
Rate for Payer: Humana Commercial $705.50
Rate for Payer: Medical Mutual Of Ohio HMO $680.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $612.54
Rate for Payer: Molina Healthcare Benefit Exchange $249.00
Rate for Payer: Ohio Health Choice Commercial $730.40
Rate for Payer: Ohio Health Group HMO $622.50
Rate for Payer: Ohio Health Group PPO Differential $166.00
Rate for Payer: Ohio Health Group PPO No Differential $107.90
Rate for Payer: Ohio Health Group PPO SOMC Employees $257.30
Rate for Payer: PHCS Commercial $796.80
Rate for Payer: United Healthcare All Payer $730.40
Service Code HCPCS 29875
Hospital Charge Code 76101097
Hospital Revenue Code 761
Min. Negotiated Rate $244.01
Max. Negotiated Rate $3,918.70
Rate for Payer: Aetna Commercial $1,445.29
Rate for Payer: Anthem Medicaid $645.50
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Anthem POS/PPO/Traditional $1,464.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Cash Price $938.50
Rate for Payer: Cash Price $938.50
Rate for Payer: Cigna Commercial $1,557.91
Rate for Payer: First Health Commercial $1,783.15
Rate for Payer: Humana Commercial $1,595.45
Rate for Payer: Humana KY Medicaid $645.50
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Kentucky WC Medicaid $652.07
Rate for Payer: Medical Mutual Of Ohio HMO $1,539.14
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,385.23
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Rate for Payer: Molina Healthcare Medicaid $658.45
Rate for Payer: Ohio Health Choice Commercial $1,651.76
Rate for Payer: Ohio Health Group HMO $1,407.75
Rate for Payer: Ohio Health Group PPO Differential $375.40
Rate for Payer: Ohio Health Group PPO No Differential $244.01
Rate for Payer: Ohio Health Group PPO SOMC Employees $581.87
Rate for Payer: PHCS Commercial $1,801.92
Rate for Payer: United Healthcare All Payer $1,651.76
Service Code HCPCS 29889
Hospital Charge Code 76102693
Hospital Revenue Code 360
Min. Negotiated Rate $498.75
Max. Negotiated Rate $1,957.16
Rate for Payer: Aetna Commercial $1,804.67
Rate for Payer: Anthem Medicaid $631.75
Rate for Payer: Buckeye Medicare Advantage $1,425.00
Rate for Payer: Cash Price $712.50
Rate for Payer: Cash Price $712.50
Rate for Payer: Cigna Commercial $1,957.16
Rate for Payer: Healthspan PPO $1,634.64
Rate for Payer: Humana Medicaid $631.75
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,522.02
Rate for Payer: Molina Healthcare CHIP/Medicaid $644.38
Rate for Payer: Molina Healthcare Passport $631.75
Rate for Payer: Multiplan PHCS $855.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $997.50
Rate for Payer: UHCCP Medicaid $498.75
Rate for Payer: Wellcare CHIP/Medicaid $638.07
Service Code HCPCS 29851
Hospital Charge Code 76101090
Hospital Revenue Code 761
Min. Negotiated Rate $699.25
Max. Negotiated Rate $2,345.00
Rate for Payer: Aetna Commercial $1,396.01
Rate for Payer: Anthem Medicaid $699.25
Rate for Payer: Buckeye Medicare Advantage $2,345.00
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cigna Commercial $1,522.63
Rate for Payer: Healthspan PPO $1,264.49
Rate for Payer: Humana Medicaid $699.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,163.65
Rate for Payer: Molina Healthcare CHIP/Medicaid $713.24
Rate for Payer: Molina Healthcare Passport $699.25
Rate for Payer: Multiplan PHCS $1,407.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,641.50
Rate for Payer: UHCCP Medicaid $820.75
Rate for Payer: Wellcare CHIP/Medicaid $706.24
Service Code HCPCS 29851
Hospital Charge Code 76101090
Hospital Revenue Code 761
Min. Negotiated Rate $304.85
Max. Negotiated Rate $2,251.20
Rate for Payer: Aetna Commercial $1,805.65
Rate for Payer: Anthem POS/PPO/Traditional $1,829.10
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cigna Commercial $1,946.35
Rate for Payer: First Health Commercial $2,227.75
Rate for Payer: Humana Commercial $1,993.25
Rate for Payer: Medical Mutual Of Ohio HMO $1,922.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,730.61
Rate for Payer: Molina Healthcare Benefit Exchange $703.50
Rate for Payer: Ohio Health Choice Commercial $2,063.60
Rate for Payer: Ohio Health Group HMO $1,758.75
Rate for Payer: Ohio Health Group PPO Differential $469.00
Rate for Payer: Ohio Health Group PPO No Differential $304.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $726.95
Rate for Payer: PHCS Commercial $2,251.20
Rate for Payer: United Healthcare All Payer $2,063.60
Service Code HCPCS 29875
Hospital Charge Code 76101097
Hospital Revenue Code 761
Min. Negotiated Rate $244.01
Max. Negotiated Rate $1,801.92
Rate for Payer: Aetna Commercial $1,445.29
Rate for Payer: Anthem POS/PPO/Traditional $1,464.06
Rate for Payer: Cash Price $938.50
Rate for Payer: Cigna Commercial $1,557.91
Rate for Payer: First Health Commercial $1,783.15
Rate for Payer: Humana Commercial $1,595.45
Rate for Payer: Medical Mutual Of Ohio HMO $1,539.14
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,385.23
Rate for Payer: Molina Healthcare Benefit Exchange $563.10
Rate for Payer: Ohio Health Choice Commercial $1,651.76
Rate for Payer: Ohio Health Group HMO $1,407.75
Rate for Payer: Ohio Health Group PPO Differential $375.40
Rate for Payer: Ohio Health Group PPO No Differential $244.01
Rate for Payer: Ohio Health Group PPO SOMC Employees $581.87
Rate for Payer: PHCS Commercial $1,801.92
Rate for Payer: United Healthcare All Payer $1,651.76
Service Code HCPCS 29851
Hospital Charge Code 76101090
Hospital Revenue Code 761
Min. Negotiated Rate $304.85
Max. Negotiated Rate $2,251.20
Rate for Payer: Aetna Commercial $1,805.65
Rate for Payer: Anthem Medicaid $806.45
Rate for Payer: Anthem Medicare Advantage/PPO $1,389.84
Rate for Payer: Anthem POS/PPO/Traditional $1,829.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $1,945.78
Rate for Payer: CareSource Just4Me Medicare $1,876.28
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cigna Commercial $1,946.35
Rate for Payer: First Health Commercial $2,227.75
Rate for Payer: Humana Commercial $1,993.25
Rate for Payer: Humana KY Medicaid $806.45
Rate for Payer: Humana Medicare Advantage $1,389.84
Rate for Payer: Kentucky WC Medicaid $814.65
Rate for Payer: Medical Mutual Of Ohio HMO $1,922.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,730.61
Rate for Payer: Molina Healthcare Benefit Exchange $1,667.81
Rate for Payer: Molina Healthcare Medicaid $822.63
Rate for Payer: Ohio Health Choice Commercial $2,063.60
Rate for Payer: Ohio Health Group HMO $1,758.75
Rate for Payer: Ohio Health Group PPO Differential $469.00
Rate for Payer: Ohio Health Group PPO No Differential $304.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $726.95
Rate for Payer: PHCS Commercial $2,251.20
Rate for Payer: United Healthcare All Payer $2,063.60
Service Code HCPCS 29873
Hospital Charge Code 76101095
Hospital Revenue Code 761
Min. Negotiated Rate $107.90
Max. Negotiated Rate $3,918.70
Rate for Payer: Aetna Commercial $639.10
Rate for Payer: Anthem Medicaid $285.44
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Anthem POS/PPO/Traditional $647.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Cash Price $415.00
Rate for Payer: Cash Price $415.00
Rate for Payer: Cigna Commercial $688.90
Rate for Payer: First Health Commercial $788.50
Rate for Payer: Humana Commercial $705.50
Rate for Payer: Humana KY Medicaid $285.44
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Kentucky WC Medicaid $288.34
Rate for Payer: Medical Mutual Of Ohio HMO $680.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $612.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Rate for Payer: Molina Healthcare Medicaid $291.16
Rate for Payer: Ohio Health Choice Commercial $730.40
Rate for Payer: Ohio Health Group HMO $622.50
Rate for Payer: Ohio Health Group PPO Differential $166.00
Rate for Payer: Ohio Health Group PPO No Differential $107.90
Rate for Payer: Ohio Health Group PPO SOMC Employees $257.30
Rate for Payer: PHCS Commercial $796.80
Rate for Payer: United Healthcare All Payer $730.40
Service Code HCPCS 29851
Hospital Charge Code 761P1090
Hospital Revenue Code 761
Min. Negotiated Rate $699.25
Max. Negotiated Rate $2,345.00
Rate for Payer: Aetna Commercial $1,396.01
Rate for Payer: Anthem Medicaid $699.25
Rate for Payer: Buckeye Medicare Advantage $2,345.00
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cash Price $1,172.50
Rate for Payer: Cigna Commercial $1,522.63
Rate for Payer: Healthspan PPO $1,264.49
Rate for Payer: Humana Medicaid $699.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,163.65
Rate for Payer: Molina Healthcare CHIP/Medicaid $713.24
Rate for Payer: Molina Healthcare Passport $699.25
Rate for Payer: Multiplan PHCS $1,407.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,641.50
Rate for Payer: UHCCP Medicaid $820.75
Rate for Payer: Wellcare CHIP/Medicaid $706.24
Service Code HCPCS 29873
Hospital Charge Code 761P1095
Hospital Revenue Code 761
Min. Negotiated Rate $290.50
Max. Negotiated Rate $830.00
Rate for Payer: Aetna Commercial $742.43
Rate for Payer: Anthem Medicaid $360.23
Rate for Payer: Buckeye Medicare Advantage $830.00
Rate for Payer: Cash Price $415.00
Rate for Payer: Cash Price $415.00
Rate for Payer: Cigna Commercial $826.96
Rate for Payer: Healthspan PPO $672.48
Rate for Payer: Humana Medicaid $360.23
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $639.49
Rate for Payer: Molina Healthcare CHIP/Medicaid $367.43
Rate for Payer: Molina Healthcare Passport $360.23
Rate for Payer: Multiplan PHCS $498.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $581.00
Rate for Payer: UHCCP Medicaid $290.50
Rate for Payer: Wellcare CHIP/Medicaid $363.83
Service Code HCPCS 29875
Hospital Charge Code 761P1097
Hospital Revenue Code 761
Min. Negotiated Rate $431.23
Max. Negotiated Rate $1,877.00
Rate for Payer: Aetna Commercial $724.11
Rate for Payer: Anthem Medicaid $431.23
Rate for Payer: Buckeye Medicare Advantage $1,877.00
Rate for Payer: Cash Price $938.50
Rate for Payer: Cash Price $938.50
Rate for Payer: Cigna Commercial $801.91
Rate for Payer: Healthspan PPO $655.89
Rate for Payer: Humana Medicaid $431.23
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $612.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $439.85
Rate for Payer: Molina Healthcare Passport $431.23
Rate for Payer: Multiplan PHCS $1,126.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,313.90
Rate for Payer: UHCCP Medicaid $656.95
Rate for Payer: Wellcare CHIP/Medicaid $435.54
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $899.24
Max. Negotiated Rate $6,640.51
Rate for Payer: Aetna Commercial $5,326.24
Rate for Payer: Anthem POS/PPO/Traditional $5,395.42
Rate for Payer: Cash Price $3,458.60
Rate for Payer: Cigna Commercial $5,741.28
Rate for Payer: First Health Commercial $6,571.34
Rate for Payer: Humana Commercial $5,879.62
Rate for Payer: Medical Mutual Of Ohio HMO $5,672.10
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $5,104.89
Rate for Payer: Molina Healthcare Benefit Exchange $2,075.16
Rate for Payer: Ohio Health Choice Commercial $6,087.14
Rate for Payer: Ohio Health Group HMO $5,187.90
Rate for Payer: Ohio Health Group PPO Differential $1,383.44
Rate for Payer: Ohio Health Group PPO No Differential $899.24
Rate for Payer: Ohio Health Group PPO SOMC Employees $2,144.33
Rate for Payer: PHCS Commercial $6,640.51
Rate for Payer: United Healthcare All Payer $6,087.14
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $899.24
Max. Negotiated Rate $6,640.51
Rate for Payer: Aetna Commercial $5,326.24
Rate for Payer: Anthem Medicaid $2,378.83
Rate for Payer: Anthem POS/PPO/Traditional $5,395.42
Rate for Payer: Cash Price $3,458.60
Rate for Payer: Cigna Commercial $5,741.28
Rate for Payer: First Health Commercial $6,571.34
Rate for Payer: Humana Commercial $5,879.62
Rate for Payer: Humana KY Medicaid $2,378.83
Rate for Payer: Kentucky WC Medicaid $2,403.04
Rate for Payer: Medical Mutual Of Ohio HMO $5,672.10
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $5,104.89
Rate for Payer: Molina Healthcare Benefit Exchange $2,075.16
Rate for Payer: Molina Healthcare Medicaid $2,426.55
Rate for Payer: Ohio Health Choice Commercial $6,087.14
Rate for Payer: Ohio Health Group HMO $5,187.90
Rate for Payer: Ohio Health Group PPO Differential $1,383.44
Rate for Payer: Ohio Health Group PPO No Differential $899.24
Rate for Payer: Ohio Health Group PPO SOMC Employees $2,144.33
Rate for Payer: PHCS Commercial $6,640.51
Rate for Payer: United Healthcare All Payer $6,087.14
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $863.65
Max. Negotiated Rate $6,377.71
Rate for Payer: Aetna Commercial $5,115.46
Rate for Payer: Anthem POS/PPO/Traditional $5,181.89
Rate for Payer: Cash Price $3,321.72
Rate for Payer: Cigna Commercial $5,514.06
Rate for Payer: First Health Commercial $6,311.28
Rate for Payer: Humana Commercial $5,646.93
Rate for Payer: Medical Mutual Of Ohio HMO $5,447.63
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $4,902.87
Rate for Payer: Molina Healthcare Benefit Exchange $1,993.04
Rate for Payer: Ohio Health Choice Commercial $5,846.24
Rate for Payer: Ohio Health Group HMO $4,982.59
Rate for Payer: Ohio Health Group PPO Differential $1,328.69
Rate for Payer: Ohio Health Group PPO No Differential $863.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $2,059.47
Rate for Payer: PHCS Commercial $6,377.71
Rate for Payer: United Healthcare All Payer $5,846.24
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $863.65
Max. Negotiated Rate $6,377.71
Rate for Payer: Aetna Commercial $5,115.46
Rate for Payer: Anthem Medicaid $2,284.68
Rate for Payer: Anthem POS/PPO/Traditional $5,181.89
Rate for Payer: Cash Price $3,321.72
Rate for Payer: Cigna Commercial $5,514.06
Rate for Payer: First Health Commercial $6,311.28
Rate for Payer: Humana Commercial $5,646.93
Rate for Payer: Humana KY Medicaid $2,284.68
Rate for Payer: Kentucky WC Medicaid $2,307.93
Rate for Payer: Medical Mutual Of Ohio HMO $5,447.63
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $4,902.87
Rate for Payer: Molina Healthcare Benefit Exchange $1,993.04
Rate for Payer: Molina Healthcare Medicaid $2,330.52
Rate for Payer: Ohio Health Choice Commercial $5,846.24
Rate for Payer: Ohio Health Group HMO $4,982.59
Rate for Payer: Ohio Health Group PPO Differential $1,328.69
Rate for Payer: Ohio Health Group PPO No Differential $863.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $2,059.47
Rate for Payer: PHCS Commercial $6,377.71
Rate for Payer: United Healthcare All Payer $5,846.24
Service Code HCPCS 73564
Hospital Charge Code 32000101
Hospital Revenue Code 320
Min. Negotiated Rate $78.78
Max. Negotiated Rate $581.76
Rate for Payer: Aetna Commercial $466.62
Rate for Payer: Anthem Medicaid $208.40
Rate for Payer: Anthem Medicare Advantage/PPO $95.07
Rate for Payer: Anthem POS/PPO/Traditional $472.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $133.10
Rate for Payer: CareSource Just4Me Medicare $128.34
Rate for Payer: Cash Price $303.00
Rate for Payer: Cash Price $303.00
Rate for Payer: Cigna Commercial $502.98
Rate for Payer: First Health Commercial $575.70
Rate for Payer: Humana Commercial $515.10
Rate for Payer: Humana KY Medicaid $208.40
Rate for Payer: Humana Medicare Advantage $95.07
Rate for Payer: Kentucky WC Medicaid $210.52
Rate for Payer: Medical Mutual Of Ohio HMO $496.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $447.23
Rate for Payer: Molina Healthcare Benefit Exchange $114.08
Rate for Payer: Molina Healthcare Medicaid $212.58
Rate for Payer: Ohio Health Choice Commercial $533.28
Rate for Payer: Ohio Health Group HMO $454.50
Rate for Payer: Ohio Health Group PPO Differential $121.20
Rate for Payer: Ohio Health Group PPO No Differential $78.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $187.86
Rate for Payer: PHCS Commercial $581.76
Rate for Payer: United Healthcare All Payer $533.28
Service Code HCPCS 73564
Hospital Charge Code 320P0101
Hospital Revenue Code 320
Min. Negotiated Rate $15.30
Max. Negotiated Rate $95.00
Rate for Payer: Aetna Commercial $59.61
Rate for Payer: Anthem Medicaid $26.42
Rate for Payer: Buckeye Medicare Advantage $95.00
Rate for Payer: Cash Price $47.50
Rate for Payer: Cash Price $47.50
Rate for Payer: Cigna Commercial $54.88
Rate for Payer: Healthspan PPO $55.86
Rate for Payer: Humana Medicaid $26.42
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $15.30
Rate for Payer: Molina Healthcare CHIP/Medicaid $26.95
Rate for Payer: Molina Healthcare Passport $26.42
Rate for Payer: Multiplan PHCS $57.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $66.50
Rate for Payer: UHCCP Medicaid $33.25
Rate for Payer: Wellcare CHIP/Medicaid $26.68
Service Code HCPCS 73564
Hospital Charge Code 320T0101
Hospital Revenue Code 320
Min. Negotiated Rate $66.43
Max. Negotiated Rate $490.56
Rate for Payer: Aetna Commercial $393.47
Rate for Payer: Anthem POS/PPO/Traditional $398.58
Rate for Payer: Cash Price $255.50
Rate for Payer: Cigna Commercial $424.13
Rate for Payer: First Health Commercial $485.45
Rate for Payer: Humana Commercial $434.35
Rate for Payer: Medical Mutual Of Ohio HMO $419.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $377.12
Rate for Payer: Molina Healthcare Benefit Exchange $153.30
Rate for Payer: Ohio Health Choice Commercial $449.68
Rate for Payer: Ohio Health Group HMO $383.25
Rate for Payer: Ohio Health Group PPO Differential $102.20
Rate for Payer: Ohio Health Group PPO No Differential $66.43
Rate for Payer: Ohio Health Group PPO SOMC Employees $158.41
Rate for Payer: PHCS Commercial $490.56
Rate for Payer: United Healthcare All Payer $449.68
Service Code HCPCS 73564
Hospital Charge Code 32000101
Hospital Revenue Code 320
Min. Negotiated Rate $78.78
Max. Negotiated Rate $581.76
Rate for Payer: Aetna Commercial $466.62
Rate for Payer: Anthem POS/PPO/Traditional $472.68
Rate for Payer: Cash Price $303.00
Rate for Payer: Cigna Commercial $502.98
Rate for Payer: First Health Commercial $575.70
Rate for Payer: Humana Commercial $515.10
Rate for Payer: Medical Mutual Of Ohio HMO $496.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $447.23
Rate for Payer: Molina Healthcare Benefit Exchange $181.80
Rate for Payer: Ohio Health Choice Commercial $533.28
Rate for Payer: Ohio Health Group HMO $454.50
Rate for Payer: Ohio Health Group PPO Differential $121.20
Rate for Payer: Ohio Health Group PPO No Differential $78.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $187.86
Rate for Payer: PHCS Commercial $581.76
Rate for Payer: United Healthcare All Payer $533.28
Service Code HCPCS 73564
Hospital Charge Code 320T0101
Hospital Revenue Code 320
Min. Negotiated Rate $66.43
Max. Negotiated Rate $490.56
Rate for Payer: Aetna Commercial $393.47
Rate for Payer: Anthem Medicaid $175.73
Rate for Payer: Anthem Medicare Advantage/PPO $95.07
Rate for Payer: Anthem POS/PPO/Traditional $398.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $133.10
Rate for Payer: CareSource Just4Me Medicare $128.34
Rate for Payer: Cash Price $255.50
Rate for Payer: Cash Price $255.50
Rate for Payer: Cigna Commercial $424.13
Rate for Payer: First Health Commercial $485.45
Rate for Payer: Humana Commercial $434.35
Rate for Payer: Humana KY Medicaid $175.73
Rate for Payer: Humana Medicare Advantage $95.07
Rate for Payer: Kentucky WC Medicaid $177.52
Rate for Payer: Medical Mutual Of Ohio HMO $419.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $377.12
Rate for Payer: Molina Healthcare Benefit Exchange $114.08
Rate for Payer: Molina Healthcare Medicaid $179.26
Rate for Payer: Ohio Health Choice Commercial $449.68
Rate for Payer: Ohio Health Group HMO $383.25
Rate for Payer: Ohio Health Group PPO Differential $102.20
Rate for Payer: Ohio Health Group PPO No Differential $66.43
Rate for Payer: Ohio Health Group PPO SOMC Employees $158.41
Rate for Payer: PHCS Commercial $490.56
Rate for Payer: United Healthcare All Payer $449.68
Service Code HCPCS 73564
Hospital Charge Code 32000101
Hospital Revenue Code 320
Min. Negotiated Rate $15.30
Max. Negotiated Rate $606.00
Rate for Payer: Aetna Commercial $59.61
Rate for Payer: Anthem Medicaid $26.42
Rate for Payer: Buckeye Medicare Advantage $606.00
Rate for Payer: Cash Price $303.00
Rate for Payer: Cash Price $303.00
Rate for Payer: Cigna Commercial $54.88
Rate for Payer: Healthspan PPO $55.86
Rate for Payer: Humana Medicaid $26.42
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $15.30
Rate for Payer: Molina Healthcare CHIP/Medicaid $26.95
Rate for Payer: Molina Healthcare Passport $26.42
Rate for Payer: Multiplan PHCS $363.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $424.20
Rate for Payer: UHCCP Medicaid $212.10
Rate for Payer: Wellcare CHIP/Medicaid $26.68
Service Code MSDRG 488
Min. Negotiated Rate $16,722.34
Max. Negotiated Rate $24,643.44
Rate for Payer: Anthem Medicaid $16,722.34
Rate for Payer: Anthem Medicare Advantage/PPO $17,602.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $24,643.44
Rate for Payer: CareSource Just4Me Medicare $23,763.32
Rate for Payer: Humana KY Medicaid $16,722.34
Rate for Payer: Humana Medicare Advantage $17,602.46
Rate for Payer: Kentucky WC Medicaid $16,889.56
Rate for Payer: Molina Healthcare Benefit Exchange $21,122.95
Rate for Payer: Molina Healthcare Medicaid $17,056.78
Service Code MSDRG 489
Min. Negotiated Rate $9,824.94
Max. Negotiated Rate $14,478.86
Rate for Payer: Anthem Medicaid $9,824.94
Rate for Payer: Anthem Medicare Advantage/PPO $10,342.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $14,478.86
Rate for Payer: CareSource Just4Me Medicare $13,961.75
Rate for Payer: Humana KY Medicaid $9,824.94
Rate for Payer: Humana Medicare Advantage $10,342.04
Rate for Payer: Kentucky WC Medicaid $9,923.19
Rate for Payer: Molina Healthcare Benefit Exchange $12,410.45
Rate for Payer: Molina Healthcare Medicaid $10,021.44
Service Code MSDRG 486
Min. Negotiated Rate $15,942.03
Max. Negotiated Rate $23,493.51
Rate for Payer: Anthem Medicaid $15,942.03
Rate for Payer: Anthem Medicare Advantage/PPO $16,781.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $23,493.51
Rate for Payer: CareSource Just4Me Medicare $22,654.46
Rate for Payer: Humana KY Medicaid $15,942.03
Rate for Payer: Humana Medicare Advantage $16,781.08
Rate for Payer: Kentucky WC Medicaid $16,101.45
Rate for Payer: Molina Healthcare Benefit Exchange $20,137.30
Rate for Payer: Molina Healthcare Medicaid $16,260.87