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Service Code NDC 25021025020
Hospital Charge Code 25003213
Hospital Revenue Code 250
Min. Negotiated Rate $172.36
Max. Negotiated Rate $1,272.79
Rate for Payer: Aetna Commercial $1,020.88
Rate for Payer: Anthem POS/PPO/Traditional $1,034.14
Rate for Payer: Cash Price $662.91
Rate for Payer: Cigna Commercial $1,100.43
Rate for Payer: First Health Commercial $1,259.53
Rate for Payer: Humana Commercial $1,126.95
Rate for Payer: Medical Mutual Of Ohio HMO $1,087.17
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $978.46
Rate for Payer: Molina Healthcare Benefit Exchange $397.75
Rate for Payer: Ohio Health Choice Commercial $1,166.72
Rate for Payer: Ohio Health Group HMO $994.36
Rate for Payer: Ohio Health Group PPO Differential $265.16
Rate for Payer: Ohio Health Group PPO No Differential $172.36
Rate for Payer: Ohio Health Group PPO SOMC Employees $411.00
Rate for Payer: PHCS Commercial $1,272.79
Rate for Payer: United Healthcare All Payer $1,166.72
Service Code HCPCS J7315
Hospital Charge Code 25004132
Hospital Revenue Code 636
Min. Negotiated Rate $204.76
Max. Negotiated Rate $1,512.05
Rate for Payer: Aetna Commercial $1,212.79
Rate for Payer: Anthem Medicaid $541.66
Rate for Payer: Anthem POS/PPO/Traditional $1,228.54
Rate for Payer: Cash Price $787.52
Rate for Payer: Cigna Commercial $1,307.29
Rate for Payer: First Health Commercial $1,496.30
Rate for Payer: Humana Commercial $1,338.79
Rate for Payer: Humana KY Medicaid $541.66
Rate for Payer: Kentucky WC Medicaid $547.17
Rate for Payer: Medical Mutual Of Ohio HMO $1,291.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,162.39
Rate for Payer: Molina Healthcare Benefit Exchange $472.52
Rate for Payer: Molina Healthcare Medicaid $552.53
Rate for Payer: Ohio Health Choice Commercial $1,386.04
Rate for Payer: Ohio Health Group HMO $1,181.29
Rate for Payer: Ohio Health Group PPO Differential $315.01
Rate for Payer: Ohio Health Group PPO No Differential $204.76
Rate for Payer: Ohio Health Group PPO SOMC Employees $488.27
Rate for Payer: PHCS Commercial $1,512.05
Rate for Payer: United Healthcare All Payer $1,386.04
Service Code HCPCS J7315
Hospital Charge Code 25004132
Hospital Revenue Code 636
Min. Negotiated Rate $204.76
Max. Negotiated Rate $1,512.05
Rate for Payer: Aetna Commercial $1,212.79
Rate for Payer: Anthem POS/PPO/Traditional $1,228.54
Rate for Payer: Cash Price $787.52
Rate for Payer: Cigna Commercial $1,307.29
Rate for Payer: First Health Commercial $1,496.30
Rate for Payer: Humana Commercial $1,338.79
Rate for Payer: Medical Mutual Of Ohio HMO $1,291.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,162.39
Rate for Payer: Molina Healthcare Benefit Exchange $472.52
Rate for Payer: Ohio Health Choice Commercial $1,386.04
Rate for Payer: Ohio Health Group HMO $1,181.29
Rate for Payer: Ohio Health Group PPO Differential $315.01
Rate for Payer: Ohio Health Group PPO No Differential $204.76
Rate for Payer: Ohio Health Group PPO SOMC Employees $488.27
Rate for Payer: PHCS Commercial $1,512.05
Rate for Payer: United Healthcare All Payer $1,386.04
Service Code HCPCS J9293
Hospital Charge Code 25002662
Hospital Revenue Code 636
Min. Negotiated Rate $43.58
Max. Negotiated Rate $523.83
Rate for Payer: Aetna Commercial $420.16
Rate for Payer: Anthem Medicaid $187.65
Rate for Payer: Anthem Medicare Advantage/PPO $43.58
Rate for Payer: Anthem POS/PPO/Traditional $425.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $61.01
Rate for Payer: CareSource Just4Me Medicare $58.83
Rate for Payer: Cash Price $272.83
Rate for Payer: Cash Price $272.83
Rate for Payer: Cigna Commercial $452.90
Rate for Payer: First Health Commercial $518.38
Rate for Payer: Humana Commercial $463.81
Rate for Payer: Humana KY Medicaid $187.65
Rate for Payer: Humana Medicare Advantage $43.58
Rate for Payer: Kentucky WC Medicaid $189.56
Rate for Payer: Medical Mutual Of Ohio HMO $447.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $402.70
Rate for Payer: Molina Healthcare Benefit Exchange $52.29
Rate for Payer: Molina Healthcare Medicaid $191.42
Rate for Payer: Ohio Health Choice Commercial $480.18
Rate for Payer: Ohio Health Group HMO $409.24
Rate for Payer: Ohio Health Group PPO Differential $109.13
Rate for Payer: Ohio Health Group PPO No Differential $70.94
Rate for Payer: Ohio Health Group PPO SOMC Employees $169.15
Rate for Payer: PHCS Commercial $523.83
Rate for Payer: United Healthcare All Payer $480.18
Service Code HCPCS J9293
Hospital Charge Code 25002662
Hospital Revenue Code 636
Min. Negotiated Rate $70.94
Max. Negotiated Rate $523.83
Rate for Payer: Aetna Commercial $420.16
Rate for Payer: Anthem POS/PPO/Traditional $425.61
Rate for Payer: Cash Price $272.83
Rate for Payer: Cigna Commercial $452.90
Rate for Payer: First Health Commercial $518.38
Rate for Payer: Humana Commercial $463.81
Rate for Payer: Medical Mutual Of Ohio HMO $447.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $402.70
Rate for Payer: Molina Healthcare Benefit Exchange $163.70
Rate for Payer: Ohio Health Choice Commercial $480.18
Rate for Payer: Ohio Health Group HMO $409.24
Rate for Payer: Ohio Health Group PPO Differential $109.13
Rate for Payer: Ohio Health Group PPO No Differential $70.94
Rate for Payer: Ohio Health Group PPO SOMC Employees $169.15
Rate for Payer: PHCS Commercial $523.83
Rate for Payer: United Healthcare All Payer $480.18
Service Code HCPCS 82800
Hospital Charge Code 30000333
Hospital Revenue Code 300
Min. Negotiated Rate $8.32
Max. Negotiated Rate $61.44
Rate for Payer: Aetna Commercial $49.28
Rate for Payer: Anthem Medicaid $11.00
Rate for Payer: Anthem Medicare Advantage/PPO $11.00
Rate for Payer: Anthem POS/PPO/Traditional $51.39
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $15.40
Rate for Payer: CareSource Just4Me Medicare $11.00
Rate for Payer: Cash Price $32.00
Rate for Payer: Cash Price $32.00
Rate for Payer: Cigna Commercial $53.12
Rate for Payer: First Health Commercial $60.80
Rate for Payer: Humana Commercial $54.40
Rate for Payer: Humana KY Medicaid $11.00
Rate for Payer: Humana Medicare Advantage $11.00
Rate for Payer: Kentucky WC Medicaid $11.11
Rate for Payer: Medical Mutual Of Ohio HMO $52.48
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.23
Rate for Payer: Molina Healthcare Benefit Exchange $13.20
Rate for Payer: Molina Healthcare Medicaid $11.22
Rate for Payer: Ohio Health Choice Commercial $56.32
Rate for Payer: Ohio Health Group HMO $48.00
Rate for Payer: Ohio Health Group PPO Differential $12.80
Rate for Payer: Ohio Health Group PPO No Differential $8.32
Rate for Payer: Ohio Health Group PPO SOMC Employees $19.84
Rate for Payer: PHCS Commercial $61.44
Rate for Payer: United Healthcare All Payer $56.32
Service Code HCPCS 82800
Hospital Charge Code 30000333
Hospital Revenue Code 300
Min. Negotiated Rate $8.32
Max. Negotiated Rate $61.44
Rate for Payer: Aetna Commercial $49.28
Rate for Payer: Anthem POS/PPO/Traditional $51.39
Rate for Payer: Cash Price $32.00
Rate for Payer: Cigna Commercial $53.12
Rate for Payer: First Health Commercial $60.80
Rate for Payer: Humana Commercial $54.40
Rate for Payer: Medical Mutual Of Ohio HMO $52.48
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.23
Rate for Payer: Molina Healthcare Benefit Exchange $19.20
Rate for Payer: Ohio Health Choice Commercial $56.32
Rate for Payer: Ohio Health Group HMO $48.00
Rate for Payer: Ohio Health Group PPO Differential $12.80
Rate for Payer: Ohio Health Group PPO No Differential $8.32
Rate for Payer: Ohio Health Group PPO SOMC Employees $19.84
Rate for Payer: PHCS Commercial $61.44
Rate for Payer: United Healthcare All Payer $56.32
Service Code HCPCS C1894
Hospital Charge Code 27000113
Hospital Revenue Code 272
Min. Negotiated Rate $140.69
Max. Negotiated Rate $1,038.91
Rate for Payer: Aetna Commercial $833.29
Rate for Payer: Anthem Medicaid $372.17
Rate for Payer: Anthem POS/PPO/Traditional $844.12
Rate for Payer: Cash Price $541.10
Rate for Payer: Cigna Commercial $898.23
Rate for Payer: First Health Commercial $1,028.09
Rate for Payer: Humana Commercial $919.87
Rate for Payer: Humana KY Medicaid $372.17
Rate for Payer: Kentucky WC Medicaid $375.96
Rate for Payer: Medical Mutual Of Ohio HMO $887.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $798.66
Rate for Payer: Molina Healthcare Benefit Exchange $324.66
Rate for Payer: Molina Healthcare Medicaid $379.64
Rate for Payer: Ohio Health Choice Commercial $952.34
Rate for Payer: Ohio Health Group HMO $811.65
Rate for Payer: Ohio Health Group PPO Differential $216.44
Rate for Payer: Ohio Health Group PPO No Differential $140.69
Rate for Payer: Ohio Health Group PPO SOMC Employees $335.48
Rate for Payer: PHCS Commercial $1,038.91
Rate for Payer: United Healthcare All Payer $952.34
Service Code HCPCS C1894
Hospital Charge Code 27000113
Hospital Revenue Code 272
Min. Negotiated Rate $140.69
Max. Negotiated Rate $1,038.91
Rate for Payer: Aetna Commercial $833.29
Rate for Payer: Anthem POS/PPO/Traditional $844.12
Rate for Payer: Cash Price $541.10
Rate for Payer: Cigna Commercial $898.23
Rate for Payer: First Health Commercial $1,028.09
Rate for Payer: Humana Commercial $919.87
Rate for Payer: Medical Mutual Of Ohio HMO $887.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $798.66
Rate for Payer: Molina Healthcare Benefit Exchange $324.66
Rate for Payer: Ohio Health Choice Commercial $952.34
Rate for Payer: Ohio Health Group HMO $811.65
Rate for Payer: Ohio Health Group PPO Differential $216.44
Rate for Payer: Ohio Health Group PPO No Differential $140.69
Rate for Payer: Ohio Health Group PPO SOMC Employees $335.48
Rate for Payer: PHCS Commercial $1,038.91
Rate for Payer: United Healthcare All Payer $952.34
Service Code HCPCS 90707
Hospital Charge Code 77000039
Hospital Revenue Code 636
Min. Negotiated Rate $31.46
Max. Negotiated Rate $232.32
Rate for Payer: Aetna Commercial $186.34
Rate for Payer: Anthem POS/PPO/Traditional $188.76
Rate for Payer: Cash Price $121.00
Rate for Payer: Cigna Commercial $200.86
Rate for Payer: First Health Commercial $229.90
Rate for Payer: Humana Commercial $205.70
Rate for Payer: Medical Mutual Of Ohio HMO $198.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $178.60
Rate for Payer: Molina Healthcare Benefit Exchange $72.60
Rate for Payer: Ohio Health Choice Commercial $212.96
Rate for Payer: Ohio Health Group HMO $181.50
Rate for Payer: Ohio Health Group PPO Differential $48.40
Rate for Payer: Ohio Health Group PPO No Differential $31.46
Rate for Payer: Ohio Health Group PPO SOMC Employees $75.02
Rate for Payer: PHCS Commercial $232.32
Rate for Payer: United Healthcare All Payer $212.96
Service Code HCPCS 90707
Hospital Charge Code 77000039
Hospital Revenue Code 636
Min. Negotiated Rate $84.70
Max. Negotiated Rate $242.00
Rate for Payer: Buckeye Medicare Advantage $242.00
Rate for Payer: Cash Price $121.00
Rate for Payer: Cash Price $121.00
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $133.19
Rate for Payer: Multiplan PHCS $145.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $169.40
Rate for Payer: UHCCP Medicaid $84.70
Service Code HCPCS 90707
Hospital Charge Code 77000039
Hospital Revenue Code 636
Min. Negotiated Rate $31.46
Max. Negotiated Rate $232.32
Rate for Payer: Aetna Commercial $186.34
Rate for Payer: Anthem Medicaid $83.22
Rate for Payer: Anthem POS/PPO/Traditional $188.76
Rate for Payer: Cash Price $121.00
Rate for Payer: Cigna Commercial $200.86
Rate for Payer: First Health Commercial $229.90
Rate for Payer: Humana Commercial $205.70
Rate for Payer: Humana KY Medicaid $83.22
Rate for Payer: Kentucky WC Medicaid $84.07
Rate for Payer: Medical Mutual Of Ohio HMO $198.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $178.60
Rate for Payer: Molina Healthcare Benefit Exchange $72.60
Rate for Payer: Molina Healthcare Medicaid $84.89
Rate for Payer: Ohio Health Choice Commercial $212.96
Rate for Payer: Ohio Health Group HMO $181.50
Rate for Payer: Ohio Health Group PPO Differential $48.40
Rate for Payer: Ohio Health Group PPO No Differential $31.46
Rate for Payer: Ohio Health Group PPO SOMC Employees $75.02
Rate for Payer: PHCS Commercial $232.32
Rate for Payer: United Healthcare All Payer $212.96
Service Code HCPCS 90707
Hospital Charge Code 770T0039
Hospital Revenue Code 636
Min. Negotiated Rate $31.46
Max. Negotiated Rate $232.32
Rate for Payer: Aetna Commercial $186.34
Rate for Payer: Anthem POS/PPO/Traditional $188.76
Rate for Payer: Cash Price $121.00
Rate for Payer: Cigna Commercial $200.86
Rate for Payer: First Health Commercial $229.90
Rate for Payer: Humana Commercial $205.70
Rate for Payer: Medical Mutual Of Ohio HMO $198.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $178.60
Rate for Payer: Molina Healthcare Benefit Exchange $72.60
Rate for Payer: Ohio Health Choice Commercial $212.96
Rate for Payer: Ohio Health Group HMO $181.50
Rate for Payer: Ohio Health Group PPO Differential $48.40
Rate for Payer: Ohio Health Group PPO No Differential $31.46
Rate for Payer: Ohio Health Group PPO SOMC Employees $75.02
Rate for Payer: PHCS Commercial $232.32
Rate for Payer: United Healthcare All Payer $212.96
Service Code HCPCS 90707
Hospital Charge Code 770T0039
Hospital Revenue Code 636
Min. Negotiated Rate $31.46
Max. Negotiated Rate $232.32
Rate for Payer: Aetna Commercial $186.34
Rate for Payer: Anthem Medicaid $83.22
Rate for Payer: Anthem POS/PPO/Traditional $188.76
Rate for Payer: Cash Price $121.00
Rate for Payer: Cigna Commercial $200.86
Rate for Payer: First Health Commercial $229.90
Rate for Payer: Humana Commercial $205.70
Rate for Payer: Humana KY Medicaid $83.22
Rate for Payer: Kentucky WC Medicaid $84.07
Rate for Payer: Medical Mutual Of Ohio HMO $198.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $178.60
Rate for Payer: Molina Healthcare Benefit Exchange $72.60
Rate for Payer: Molina Healthcare Medicaid $84.89
Rate for Payer: Ohio Health Choice Commercial $212.96
Rate for Payer: Ohio Health Group HMO $181.50
Rate for Payer: Ohio Health Group PPO Differential $48.40
Rate for Payer: Ohio Health Group PPO No Differential $31.46
Rate for Payer: Ohio Health Group PPO SOMC Employees $75.02
Rate for Payer: PHCS Commercial $232.32
Rate for Payer: United Healthcare All Payer $212.96
Service Code HCPCS 90710
Hospital Charge Code 77000040
Hospital Revenue Code 636
Min. Negotiated Rate $140.00
Max. Negotiated Rate $528.00
Rate for Payer: Buckeye Medicare Advantage $528.00
Rate for Payer: Cash Price $264.00
Rate for Payer: Cash Price $264.00
Rate for Payer: Healthspan PPO $140.00
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $400.81
Rate for Payer: Multiplan PHCS $316.80
Rate for Payer: Ohio Health Choice Preferred Health Choice $369.60
Rate for Payer: UHCCP Medicaid $184.80
Service Code HCPCS 90710
Hospital Charge Code 77000040
Hospital Revenue Code 636
Min. Negotiated Rate $68.64
Max. Negotiated Rate $506.88
Rate for Payer: Aetna Commercial $406.56
Rate for Payer: Anthem POS/PPO/Traditional $411.84
Rate for Payer: Cash Price $264.00
Rate for Payer: Cigna Commercial $438.24
Rate for Payer: First Health Commercial $501.60
Rate for Payer: Humana Commercial $448.80
Rate for Payer: Medical Mutual Of Ohio HMO $432.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $389.66
Rate for Payer: Molina Healthcare Benefit Exchange $158.40
Rate for Payer: Ohio Health Choice Commercial $464.64
Rate for Payer: Ohio Health Group HMO $396.00
Rate for Payer: Ohio Health Group PPO Differential $105.60
Rate for Payer: Ohio Health Group PPO No Differential $68.64
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.68
Rate for Payer: PHCS Commercial $506.88
Rate for Payer: United Healthcare All Payer $464.64
Service Code HCPCS 90710
Hospital Charge Code 77000040
Hospital Revenue Code 636
Min. Negotiated Rate $68.64
Max. Negotiated Rate $506.88
Rate for Payer: Aetna Commercial $406.56
Rate for Payer: Anthem Medicaid $181.58
Rate for Payer: Anthem Medicare Advantage/PPO $120.43
Rate for Payer: Anthem POS/PPO/Traditional $411.84
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $168.60
Rate for Payer: CareSource Just4Me Medicare $162.58
Rate for Payer: Cash Price $264.00
Rate for Payer: Cash Price $264.00
Rate for Payer: Cigna Commercial $438.24
Rate for Payer: First Health Commercial $501.60
Rate for Payer: Humana Commercial $448.80
Rate for Payer: Humana KY Medicaid $181.58
Rate for Payer: Humana Medicare Advantage $120.43
Rate for Payer: Kentucky WC Medicaid $183.43
Rate for Payer: Medical Mutual Of Ohio HMO $432.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $389.66
Rate for Payer: Molina Healthcare Benefit Exchange $144.52
Rate for Payer: Molina Healthcare Medicaid $185.22
Rate for Payer: Ohio Health Choice Commercial $464.64
Rate for Payer: Ohio Health Group HMO $396.00
Rate for Payer: Ohio Health Group PPO Differential $105.60
Rate for Payer: Ohio Health Group PPO No Differential $68.64
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.68
Rate for Payer: PHCS Commercial $506.88
Rate for Payer: United Healthcare All Payer $464.64
Service Code HCPCS 90710
Hospital Charge Code 770T0040
Hospital Revenue Code 636
Min. Negotiated Rate $68.64
Max. Negotiated Rate $506.88
Rate for Payer: Aetna Commercial $406.56
Rate for Payer: Anthem POS/PPO/Traditional $411.84
Rate for Payer: Cash Price $264.00
Rate for Payer: Cigna Commercial $438.24
Rate for Payer: First Health Commercial $501.60
Rate for Payer: Humana Commercial $448.80
Rate for Payer: Medical Mutual Of Ohio HMO $432.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $389.66
Rate for Payer: Molina Healthcare Benefit Exchange $158.40
Rate for Payer: Ohio Health Choice Commercial $464.64
Rate for Payer: Ohio Health Group HMO $396.00
Rate for Payer: Ohio Health Group PPO Differential $105.60
Rate for Payer: Ohio Health Group PPO No Differential $68.64
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.68
Rate for Payer: PHCS Commercial $506.88
Rate for Payer: United Healthcare All Payer $464.64
Service Code HCPCS 90710
Hospital Charge Code 770T0040
Hospital Revenue Code 636
Min. Negotiated Rate $68.64
Max. Negotiated Rate $506.88
Rate for Payer: Aetna Commercial $406.56
Rate for Payer: Anthem Medicaid $181.58
Rate for Payer: Anthem Medicare Advantage/PPO $120.43
Rate for Payer: Anthem POS/PPO/Traditional $411.84
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $168.60
Rate for Payer: CareSource Just4Me Medicare $162.58
Rate for Payer: Cash Price $264.00
Rate for Payer: Cash Price $264.00
Rate for Payer: Cigna Commercial $438.24
Rate for Payer: First Health Commercial $501.60
Rate for Payer: Humana Commercial $448.80
Rate for Payer: Humana KY Medicaid $181.58
Rate for Payer: Humana Medicare Advantage $120.43
Rate for Payer: Kentucky WC Medicaid $183.43
Rate for Payer: Medical Mutual Of Ohio HMO $432.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $389.66
Rate for Payer: Molina Healthcare Benefit Exchange $144.52
Rate for Payer: Molina Healthcare Medicaid $185.22
Rate for Payer: Ohio Health Choice Commercial $464.64
Rate for Payer: Ohio Health Group HMO $396.00
Rate for Payer: Ohio Health Group PPO Differential $105.60
Rate for Payer: Ohio Health Group PPO No Differential $68.64
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.68
Rate for Payer: PHCS Commercial $506.88
Rate for Payer: United Healthcare All Payer $464.64
Service Code HCPCS 20700
Hospital Charge Code 76102822
Hospital Revenue Code 761
Min. Negotiated Rate $13.65
Max. Negotiated Rate $100.80
Rate for Payer: Aetna Commercial $80.85
Rate for Payer: Anthem Medicaid $36.11
Rate for Payer: Anthem POS/PPO/Traditional $81.90
Rate for Payer: Cash Price $52.50
Rate for Payer: Cigna Commercial $87.15
Rate for Payer: First Health Commercial $99.75
Rate for Payer: Humana Commercial $89.25
Rate for Payer: Humana KY Medicaid $36.11
Rate for Payer: Kentucky WC Medicaid $36.48
Rate for Payer: Medical Mutual Of Ohio HMO $86.10
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $77.49
Rate for Payer: Molina Healthcare Benefit Exchange $31.50
Rate for Payer: Molina Healthcare Medicaid $36.83
Rate for Payer: Ohio Health Choice Commercial $92.40
Rate for Payer: Ohio Health Group HMO $78.75
Rate for Payer: Ohio Health Group PPO Differential $21.00
Rate for Payer: Ohio Health Group PPO No Differential $13.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $32.55
Rate for Payer: PHCS Commercial $100.80
Rate for Payer: United Healthcare All Payer $92.40
Service Code HCPCS 20700
Hospital Charge Code 76102822
Hospital Revenue Code 761
Min. Negotiated Rate $13.65
Max. Negotiated Rate $100.80
Rate for Payer: Aetna Commercial $80.85
Rate for Payer: Anthem POS/PPO/Traditional $81.90
Rate for Payer: Cash Price $52.50
Rate for Payer: Cigna Commercial $87.15
Rate for Payer: First Health Commercial $99.75
Rate for Payer: Humana Commercial $89.25
Rate for Payer: Medical Mutual Of Ohio HMO $86.10
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $77.49
Rate for Payer: Molina Healthcare Benefit Exchange $31.50
Rate for Payer: Ohio Health Choice Commercial $92.40
Rate for Payer: Ohio Health Group HMO $78.75
Rate for Payer: Ohio Health Group PPO Differential $21.00
Rate for Payer: Ohio Health Group PPO No Differential $13.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $32.55
Rate for Payer: PHCS Commercial $100.80
Rate for Payer: United Healthcare All Payer $92.40
Service Code HCPCS 20700
Hospital Charge Code 76102822
Hospital Revenue Code 761
Min. Negotiated Rate $36.75
Max. Negotiated Rate $115.28
Rate for Payer: Anthem Medicaid $67.81
Rate for Payer: Buckeye Medicare Advantage $105.00
Rate for Payer: Cash Price $52.50
Rate for Payer: Cash Price $52.50
Rate for Payer: Humana Medicaid $67.81
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $115.28
Rate for Payer: Molina Healthcare CHIP/Medicaid $69.17
Rate for Payer: Molina Healthcare Passport $67.81
Rate for Payer: Multiplan PHCS $63.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $73.50
Rate for Payer: UHCCP Medicaid $36.75
Rate for Payer: Wellcare CHIP/Medicaid $68.49
Service Code HCPCS 20704
Hospital Charge Code 76102861
Hospital Revenue Code 761
Min. Negotiated Rate $22.10
Max. Negotiated Rate $163.20
Rate for Payer: Aetna Commercial $130.90
Rate for Payer: Anthem Medicaid $58.46
Rate for Payer: Anthem POS/PPO/Traditional $132.60
Rate for Payer: Cash Price $85.00
Rate for Payer: Cigna Commercial $141.10
Rate for Payer: First Health Commercial $161.50
Rate for Payer: Humana Commercial $144.50
Rate for Payer: Humana KY Medicaid $58.46
Rate for Payer: Kentucky WC Medicaid $59.06
Rate for Payer: Medical Mutual Of Ohio HMO $139.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $125.46
Rate for Payer: Molina Healthcare Benefit Exchange $51.00
Rate for Payer: Molina Healthcare Medicaid $59.64
Rate for Payer: Ohio Health Choice Commercial $149.60
Rate for Payer: Ohio Health Group HMO $127.50
Rate for Payer: Ohio Health Group PPO Differential $34.00
Rate for Payer: Ohio Health Group PPO No Differential $22.10
Rate for Payer: Ohio Health Group PPO SOMC Employees $52.70
Rate for Payer: PHCS Commercial $163.20
Rate for Payer: United Healthcare All Payer $149.60
Service Code HCPCS 20704
Hospital Charge Code 76102861
Hospital Revenue Code 761
Min. Negotiated Rate $59.50
Max. Negotiated Rate $199.92
Rate for Payer: Anthem Medicaid $117.53
Rate for Payer: Buckeye Medicare Advantage $170.00
Rate for Payer: Cash Price $85.00
Rate for Payer: Cash Price $85.00
Rate for Payer: Humana Medicaid $117.53
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $199.92
Rate for Payer: Molina Healthcare CHIP/Medicaid $119.88
Rate for Payer: Molina Healthcare Passport $117.53
Rate for Payer: Multiplan PHCS $102.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $119.00
Rate for Payer: UHCCP Medicaid $59.50
Rate for Payer: Wellcare CHIP/Medicaid $118.71
Service Code HCPCS 20704
Hospital Charge Code 76102861
Hospital Revenue Code 761
Min. Negotiated Rate $22.10
Max. Negotiated Rate $163.20
Rate for Payer: Aetna Commercial $130.90
Rate for Payer: Anthem POS/PPO/Traditional $132.60
Rate for Payer: Cash Price $85.00
Rate for Payer: Cigna Commercial $141.10
Rate for Payer: First Health Commercial $161.50
Rate for Payer: Humana Commercial $144.50
Rate for Payer: Medical Mutual Of Ohio HMO $139.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $125.46
Rate for Payer: Molina Healthcare Benefit Exchange $51.00
Rate for Payer: Ohio Health Choice Commercial $149.60
Rate for Payer: Ohio Health Group HMO $127.50
Rate for Payer: Ohio Health Group PPO Differential $34.00
Rate for Payer: Ohio Health Group PPO No Differential $22.10
Rate for Payer: Ohio Health Group PPO SOMC Employees $52.70
Rate for Payer: PHCS Commercial $163.20
Rate for Payer: United Healthcare All Payer $149.60