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Service Code HCPCS 86003
Hospital Charge Code 30000855
Hospital Revenue Code 302
Min. Negotiated Rate $5.22
Max. Negotiated Rate $62.40
Rate for Payer: Aetna Commercial $50.05
Rate for Payer: Anthem Medicaid $5.22
Rate for Payer: Anthem Medicare Advantage/PPO $5.22
Rate for Payer: Anthem POS/PPO/Traditional $52.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $7.31
Rate for Payer: CareSource Just4Me Medicare $5.22
Rate for Payer: Cash Price $32.50
Rate for Payer: Cash Price $32.50
Rate for Payer: Cigna Commercial $53.95
Rate for Payer: First Health Commercial $61.75
Rate for Payer: Humana Commercial $55.25
Rate for Payer: Humana KY Medicaid $5.22
Rate for Payer: Humana Medicare Advantage $5.22
Rate for Payer: Kentucky WC Medicaid $5.27
Rate for Payer: Medical Mutual Of Ohio HMO $53.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.97
Rate for Payer: Molina Healthcare Benefit Exchange $6.26
Rate for Payer: Molina Healthcare Medicaid $5.32
Rate for Payer: Ohio Health Choice Commercial $57.20
Rate for Payer: Ohio Health Group HMO $48.75
Rate for Payer: Ohio Health Group PPO Differential $13.00
Rate for Payer: Ohio Health Group PPO No Differential $8.45
Rate for Payer: Ohio Health Group PPO SOMC Employees $20.15
Rate for Payer: PHCS Commercial $62.40
Rate for Payer: United Healthcare All Payer $57.20
Service Code HCPCS 86003
Hospital Charge Code 30000855
Hospital Revenue Code 302
Min. Negotiated Rate $8.45
Max. Negotiated Rate $62.40
Rate for Payer: Aetna Commercial $50.05
Rate for Payer: Anthem POS/PPO/Traditional $52.20
Rate for Payer: Cash Price $32.50
Rate for Payer: Cigna Commercial $53.95
Rate for Payer: First Health Commercial $61.75
Rate for Payer: Humana Commercial $55.25
Rate for Payer: Medical Mutual Of Ohio HMO $53.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.97
Rate for Payer: Molina Healthcare Benefit Exchange $19.50
Rate for Payer: Ohio Health Choice Commercial $57.20
Rate for Payer: Ohio Health Group HMO $48.75
Rate for Payer: Ohio Health Group PPO Differential $13.00
Rate for Payer: Ohio Health Group PPO No Differential $8.45
Rate for Payer: Ohio Health Group PPO SOMC Employees $20.15
Rate for Payer: PHCS Commercial $62.40
Rate for Payer: United Healthcare All Payer $57.20
Service Code HCPCS 87635
Hospital Charge Code 30001783
Hospital Revenue Code 300
Min. Negotiated Rate $17.68
Max. Negotiated Rate $130.56
Rate for Payer: Aetna Commercial $104.72
Rate for Payer: Anthem Medicaid $51.31
Rate for Payer: Anthem Medicare Advantage/PPO $51.31
Rate for Payer: Anthem POS/PPO/Traditional $109.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $71.83
Rate for Payer: CareSource Just4Me Medicare $51.31
Rate for Payer: Cash Price $68.00
Rate for Payer: Cash Price $68.00
Rate for Payer: Cigna Commercial $112.88
Rate for Payer: First Health Commercial $129.20
Rate for Payer: Humana Commercial $115.60
Rate for Payer: Humana KY Medicaid $51.31
Rate for Payer: Humana Medicare Advantage $51.31
Rate for Payer: Kentucky WC Medicaid $51.82
Rate for Payer: Medical Mutual Of Ohio HMO $111.52
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $100.37
Rate for Payer: Molina Healthcare Benefit Exchange $61.57
Rate for Payer: Molina Healthcare Medicaid $52.34
Rate for Payer: Ohio Health Choice Commercial $119.68
Rate for Payer: Ohio Health Group HMO $102.00
Rate for Payer: Ohio Health Group PPO Differential $27.20
Rate for Payer: Ohio Health Group PPO No Differential $17.68
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.16
Rate for Payer: PHCS Commercial $130.56
Rate for Payer: United Healthcare All Payer $119.68
Service Code HCPCS 87635
Hospital Charge Code 30001783
Hospital Revenue Code 300
Min. Negotiated Rate $30.79
Max. Negotiated Rate $136.00
Rate for Payer: Buckeye Medicare Advantage $136.00
Rate for Payer: Cash Price $68.00
Rate for Payer: Cash Price $68.00
Rate for Payer: Multiplan PHCS $81.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $95.20
Rate for Payer: UHCCP Medicaid $47.60
Rate for Payer: Wellcare CHIP/Medicaid $30.79
Service Code HCPCS 87635
Hospital Charge Code 30001783
Hospital Revenue Code 300
Min. Negotiated Rate $17.68
Max. Negotiated Rate $130.56
Rate for Payer: Aetna Commercial $104.72
Rate for Payer: Anthem POS/PPO/Traditional $109.21
Rate for Payer: Cash Price $68.00
Rate for Payer: Cigna Commercial $112.88
Rate for Payer: First Health Commercial $129.20
Rate for Payer: Humana Commercial $115.60
Rate for Payer: Medical Mutual Of Ohio HMO $111.52
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $100.37
Rate for Payer: Molina Healthcare Benefit Exchange $40.80
Rate for Payer: Ohio Health Choice Commercial $119.68
Rate for Payer: Ohio Health Group HMO $102.00
Rate for Payer: Ohio Health Group PPO Differential $27.20
Rate for Payer: Ohio Health Group PPO No Differential $17.68
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.16
Rate for Payer: PHCS Commercial $130.56
Rate for Payer: United Healthcare All Payer $119.68
Service Code HCPCS 86769
Hospital Charge Code 30001788
Hospital Revenue Code 300
Min. Negotiated Rate $14.04
Max. Negotiated Rate $103.68
Rate for Payer: Aetna Commercial $83.16
Rate for Payer: Anthem POS/PPO/Traditional $86.72
Rate for Payer: Cash Price $54.00
Rate for Payer: Cigna Commercial $89.64
Rate for Payer: First Health Commercial $102.60
Rate for Payer: Humana Commercial $91.80
Rate for Payer: Medical Mutual Of Ohio HMO $88.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $79.70
Rate for Payer: Molina Healthcare Benefit Exchange $32.40
Rate for Payer: Ohio Health Choice Commercial $95.04
Rate for Payer: Ohio Health Group HMO $81.00
Rate for Payer: Ohio Health Group PPO Differential $21.60
Rate for Payer: Ohio Health Group PPO No Differential $14.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $33.48
Rate for Payer: PHCS Commercial $103.68
Rate for Payer: United Healthcare All Payer $95.04
Service Code HCPCS 86769
Hospital Charge Code 30001788
Hospital Revenue Code 300
Min. Negotiated Rate $14.04
Max. Negotiated Rate $103.68
Rate for Payer: Aetna Commercial $83.16
Rate for Payer: Anthem Medicaid $42.13
Rate for Payer: Anthem Medicare Advantage/PPO $42.13
Rate for Payer: Anthem POS/PPO/Traditional $86.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $58.98
Rate for Payer: CareSource Just4Me Medicare $42.13
Rate for Payer: Cash Price $54.00
Rate for Payer: Cash Price $54.00
Rate for Payer: Cigna Commercial $89.64
Rate for Payer: First Health Commercial $102.60
Rate for Payer: Humana Commercial $91.80
Rate for Payer: Humana KY Medicaid $42.13
Rate for Payer: Humana Medicare Advantage $42.13
Rate for Payer: Kentucky WC Medicaid $42.55
Rate for Payer: Medical Mutual Of Ohio HMO $88.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $79.70
Rate for Payer: Molina Healthcare Benefit Exchange $50.56
Rate for Payer: Molina Healthcare Medicaid $42.97
Rate for Payer: Ohio Health Choice Commercial $95.04
Rate for Payer: Ohio Health Group HMO $81.00
Rate for Payer: Ohio Health Group PPO Differential $21.60
Rate for Payer: Ohio Health Group PPO No Differential $14.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $33.48
Rate for Payer: PHCS Commercial $103.68
Rate for Payer: United Healthcare All Payer $95.04
Service Code HCPCS 86769
Hospital Charge Code 30001788
Hospital Revenue Code 300
Min. Negotiated Rate $25.28
Max. Negotiated Rate $108.00
Rate for Payer: Buckeye Medicare Advantage $108.00
Rate for Payer: Cash Price $54.00
Rate for Payer: Cash Price $54.00
Rate for Payer: Multiplan PHCS $64.80
Rate for Payer: Ohio Health Choice Preferred Health Choice $75.60
Rate for Payer: UHCCP Medicaid $37.80
Rate for Payer: Wellcare CHIP/Medicaid $25.28
Service Code HCPCS 86003
Hospital Charge Code 30000800
Hospital Revenue Code 302
Min. Negotiated Rate $5.22
Max. Negotiated Rate $62.40
Rate for Payer: Aetna Commercial $50.05
Rate for Payer: Anthem Medicaid $5.22
Rate for Payer: Anthem Medicare Advantage/PPO $5.22
Rate for Payer: Anthem POS/PPO/Traditional $52.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $7.31
Rate for Payer: CareSource Just4Me Medicare $5.22
Rate for Payer: Cash Price $32.50
Rate for Payer: Cash Price $32.50
Rate for Payer: Cigna Commercial $53.95
Rate for Payer: First Health Commercial $61.75
Rate for Payer: Humana Commercial $55.25
Rate for Payer: Humana KY Medicaid $5.22
Rate for Payer: Humana Medicare Advantage $5.22
Rate for Payer: Kentucky WC Medicaid $5.27
Rate for Payer: Medical Mutual Of Ohio HMO $53.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.97
Rate for Payer: Molina Healthcare Benefit Exchange $6.26
Rate for Payer: Molina Healthcare Medicaid $5.32
Rate for Payer: Ohio Health Choice Commercial $57.20
Rate for Payer: Ohio Health Group HMO $48.75
Rate for Payer: Ohio Health Group PPO Differential $13.00
Rate for Payer: Ohio Health Group PPO No Differential $8.45
Rate for Payer: Ohio Health Group PPO SOMC Employees $20.15
Rate for Payer: PHCS Commercial $62.40
Rate for Payer: United Healthcare All Payer $57.20
Service Code HCPCS 86003
Hospital Charge Code 30000800
Hospital Revenue Code 302
Min. Negotiated Rate $8.45
Max. Negotiated Rate $62.40
Rate for Payer: Aetna Commercial $50.05
Rate for Payer: Anthem POS/PPO/Traditional $52.20
Rate for Payer: Cash Price $32.50
Rate for Payer: Cigna Commercial $53.95
Rate for Payer: First Health Commercial $61.75
Rate for Payer: Humana Commercial $55.25
Rate for Payer: Medical Mutual Of Ohio HMO $53.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $47.97
Rate for Payer: Molina Healthcare Benefit Exchange $19.50
Rate for Payer: Ohio Health Choice Commercial $57.20
Rate for Payer: Ohio Health Group HMO $48.75
Rate for Payer: Ohio Health Group PPO Differential $13.00
Rate for Payer: Ohio Health Group PPO No Differential $8.45
Rate for Payer: Ohio Health Group PPO SOMC Employees $20.15
Rate for Payer: PHCS Commercial $62.40
Rate for Payer: United Healthcare All Payer $57.20
Service Code HCPCS G0480
Hospital Charge Code 30000120
Hospital Revenue Code 300
Min. Negotiated Rate $25.35
Max. Negotiated Rate $187.20
Rate for Payer: Aetna Commercial $150.15
Rate for Payer: Anthem Medicaid $114.43
Rate for Payer: Anthem Medicare Advantage/PPO $114.43
Rate for Payer: Anthem POS/PPO/Traditional $156.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $160.20
Rate for Payer: CareSource Just4Me Medicare $114.43
Rate for Payer: Cash Price $97.50
Rate for Payer: Cash Price $97.50
Rate for Payer: Cigna Commercial $161.85
Rate for Payer: First Health Commercial $185.25
Rate for Payer: Humana Commercial $165.75
Rate for Payer: Humana KY Medicaid $114.43
Rate for Payer: Humana Medicare Advantage $114.43
Rate for Payer: Kentucky WC Medicaid $115.57
Rate for Payer: Medical Mutual Of Ohio HMO $159.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $143.91
Rate for Payer: Molina Healthcare Benefit Exchange $137.32
Rate for Payer: Molina Healthcare Medicaid $116.72
Rate for Payer: Ohio Health Choice Commercial $171.60
Rate for Payer: Ohio Health Group HMO $146.25
Rate for Payer: Ohio Health Group PPO Differential $39.00
Rate for Payer: Ohio Health Group PPO No Differential $25.35
Rate for Payer: Ohio Health Group PPO SOMC Employees $60.45
Rate for Payer: PHCS Commercial $187.20
Rate for Payer: United Healthcare All Payer $171.60
Service Code HCPCS G0480
Hospital Charge Code 30000120
Hospital Revenue Code 300
Min. Negotiated Rate $25.35
Max. Negotiated Rate $187.20
Rate for Payer: Aetna Commercial $150.15
Rate for Payer: Anthem POS/PPO/Traditional $156.58
Rate for Payer: Cash Price $97.50
Rate for Payer: Cigna Commercial $161.85
Rate for Payer: First Health Commercial $185.25
Rate for Payer: Humana Commercial $165.75
Rate for Payer: Medical Mutual Of Ohio HMO $159.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $143.91
Rate for Payer: Molina Healthcare Benefit Exchange $58.50
Rate for Payer: Ohio Health Choice Commercial $171.60
Rate for Payer: Ohio Health Group HMO $146.25
Rate for Payer: Ohio Health Group PPO Differential $39.00
Rate for Payer: Ohio Health Group PPO No Differential $25.35
Rate for Payer: Ohio Health Group PPO SOMC Employees $60.45
Rate for Payer: PHCS Commercial $187.20
Rate for Payer: United Healthcare All Payer $171.60
Service Code HCPCS 86235
Hospital Charge Code 30001004
Hospital Revenue Code 300
Min. Negotiated Rate $25.09
Max. Negotiated Rate $185.28
Rate for Payer: Aetna Commercial $148.61
Rate for Payer: Anthem POS/PPO/Traditional $154.98
Rate for Payer: Cash Price $96.50
Rate for Payer: Cigna Commercial $160.19
Rate for Payer: First Health Commercial $183.35
Rate for Payer: Humana Commercial $164.05
Rate for Payer: Medical Mutual Of Ohio HMO $158.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $142.43
Rate for Payer: Molina Healthcare Benefit Exchange $57.90
Rate for Payer: Ohio Health Choice Commercial $169.84
Rate for Payer: Ohio Health Group HMO $144.75
Rate for Payer: Ohio Health Group PPO Differential $38.60
Rate for Payer: Ohio Health Group PPO No Differential $25.09
Rate for Payer: Ohio Health Group PPO SOMC Employees $59.83
Rate for Payer: PHCS Commercial $185.28
Rate for Payer: United Healthcare All Payer $169.84
Service Code HCPCS 86235
Hospital Charge Code 30001004
Hospital Revenue Code 300
Min. Negotiated Rate $17.93
Max. Negotiated Rate $185.28
Rate for Payer: Aetna Commercial $148.61
Rate for Payer: Anthem Medicaid $17.93
Rate for Payer: Anthem Medicare Advantage/PPO $17.93
Rate for Payer: Anthem POS/PPO/Traditional $154.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $25.10
Rate for Payer: CareSource Just4Me Medicare $17.93
Rate for Payer: Cash Price $96.50
Rate for Payer: Cash Price $96.50
Rate for Payer: Cigna Commercial $160.19
Rate for Payer: First Health Commercial $183.35
Rate for Payer: Humana Commercial $164.05
Rate for Payer: Humana KY Medicaid $17.93
Rate for Payer: Humana Medicare Advantage $17.93
Rate for Payer: Kentucky WC Medicaid $18.11
Rate for Payer: Medical Mutual Of Ohio HMO $158.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $142.43
Rate for Payer: Molina Healthcare Benefit Exchange $21.52
Rate for Payer: Molina Healthcare Medicaid $18.29
Rate for Payer: Ohio Health Choice Commercial $169.84
Rate for Payer: Ohio Health Group HMO $144.75
Rate for Payer: Ohio Health Group PPO Differential $38.60
Rate for Payer: Ohio Health Group PPO No Differential $25.09
Rate for Payer: Ohio Health Group PPO SOMC Employees $59.83
Rate for Payer: PHCS Commercial $185.28
Rate for Payer: United Healthcare All Payer $169.84
Service Code HCPCS G0480
Hospital Charge Code 30000163
Hospital Revenue Code 300
Min. Negotiated Rate $3.38
Max. Negotiated Rate $24.96
Rate for Payer: Aetna Commercial $20.02
Rate for Payer: Anthem POS/PPO/Traditional $20.88
Rate for Payer: Cash Price $13.00
Rate for Payer: Cigna Commercial $21.58
Rate for Payer: First Health Commercial $24.70
Rate for Payer: Humana Commercial $22.10
Rate for Payer: Medical Mutual Of Ohio HMO $21.32
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $19.19
Rate for Payer: Molina Healthcare Benefit Exchange $7.80
Rate for Payer: Ohio Health Choice Commercial $22.88
Rate for Payer: Ohio Health Group HMO $19.50
Rate for Payer: Ohio Health Group PPO Differential $5.20
Rate for Payer: Ohio Health Group PPO No Differential $3.38
Rate for Payer: Ohio Health Group PPO SOMC Employees $8.06
Rate for Payer: PHCS Commercial $24.96
Rate for Payer: United Healthcare All Payer $22.88
Service Code HCPCS G0480
Hospital Charge Code 30000163
Hospital Revenue Code 300
Min. Negotiated Rate $3.38
Max. Negotiated Rate $160.20
Rate for Payer: Aetna Commercial $20.02
Rate for Payer: Anthem Medicaid $114.43
Rate for Payer: Anthem Medicare Advantage/PPO $114.43
Rate for Payer: Anthem POS/PPO/Traditional $20.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $160.20
Rate for Payer: CareSource Just4Me Medicare $114.43
Rate for Payer: Cash Price $13.00
Rate for Payer: Cash Price $13.00
Rate for Payer: Cigna Commercial $21.58
Rate for Payer: First Health Commercial $24.70
Rate for Payer: Humana Commercial $22.10
Rate for Payer: Humana KY Medicaid $114.43
Rate for Payer: Humana Medicare Advantage $114.43
Rate for Payer: Kentucky WC Medicaid $115.57
Rate for Payer: Medical Mutual Of Ohio HMO $21.32
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $19.19
Rate for Payer: Molina Healthcare Benefit Exchange $137.32
Rate for Payer: Molina Healthcare Medicaid $116.72
Rate for Payer: Ohio Health Choice Commercial $22.88
Rate for Payer: Ohio Health Group HMO $19.50
Rate for Payer: Ohio Health Group PPO Differential $5.20
Rate for Payer: Ohio Health Group PPO No Differential $3.38
Rate for Payer: Ohio Health Group PPO SOMC Employees $8.06
Rate for Payer: PHCS Commercial $24.96
Rate for Payer: United Healthcare All Payer $22.88
Service Code HCPCS 80368
Hospital Charge Code 30000163
Hospital Revenue Code 300
Min. Negotiated Rate $9.10
Max. Negotiated Rate $26.00
Rate for Payer: Buckeye Medicare Advantage $26.00
Rate for Payer: Cash Price $13.00
Rate for Payer: Multiplan PHCS $15.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $18.20
Rate for Payer: UHCCP Medicaid $9.10
Service Code HCPCS 84255
Hospital Charge Code 30000508
Hospital Revenue Code 300
Min. Negotiated Rate $25.53
Max. Negotiated Rate $217.92
Rate for Payer: Aetna Commercial $174.79
Rate for Payer: Anthem Medicaid $25.53
Rate for Payer: Anthem Medicare Advantage/PPO $25.53
Rate for Payer: Anthem POS/PPO/Traditional $182.28
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $35.74
Rate for Payer: CareSource Just4Me Medicare $25.53
Rate for Payer: Cash Price $113.50
Rate for Payer: Cash Price $113.50
Rate for Payer: Cigna Commercial $188.41
Rate for Payer: First Health Commercial $215.65
Rate for Payer: Humana Commercial $192.95
Rate for Payer: Humana KY Medicaid $25.53
Rate for Payer: Humana Medicare Advantage $25.53
Rate for Payer: Kentucky WC Medicaid $25.79
Rate for Payer: Medical Mutual Of Ohio HMO $186.14
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $167.53
Rate for Payer: Molina Healthcare Benefit Exchange $30.64
Rate for Payer: Molina Healthcare Medicaid $26.04
Rate for Payer: Ohio Health Choice Commercial $199.76
Rate for Payer: Ohio Health Group HMO $170.25
Rate for Payer: Ohio Health Group PPO Differential $45.40
Rate for Payer: Ohio Health Group PPO No Differential $29.51
Rate for Payer: Ohio Health Group PPO SOMC Employees $70.37
Rate for Payer: PHCS Commercial $217.92
Rate for Payer: United Healthcare All Payer $199.76
Service Code HCPCS 84255
Hospital Charge Code 30000508
Hospital Revenue Code 300
Min. Negotiated Rate $29.51
Max. Negotiated Rate $217.92
Rate for Payer: Aetna Commercial $174.79
Rate for Payer: Anthem POS/PPO/Traditional $182.28
Rate for Payer: Cash Price $113.50
Rate for Payer: Cigna Commercial $188.41
Rate for Payer: First Health Commercial $215.65
Rate for Payer: Humana Commercial $192.95
Rate for Payer: Medical Mutual Of Ohio HMO $186.14
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $167.53
Rate for Payer: Molina Healthcare Benefit Exchange $68.10
Rate for Payer: Ohio Health Choice Commercial $199.76
Rate for Payer: Ohio Health Group HMO $170.25
Rate for Payer: Ohio Health Group PPO Differential $45.40
Rate for Payer: Ohio Health Group PPO No Differential $29.51
Rate for Payer: Ohio Health Group PPO SOMC Employees $70.37
Rate for Payer: PHCS Commercial $217.92
Rate for Payer: United Healthcare All Payer $199.76
Service Code HCPCS G0480
Hospital Charge Code 30000104
Hospital Revenue Code 300
Min. Negotiated Rate $16.12
Max. Negotiated Rate $160.20
Rate for Payer: Aetna Commercial $95.48
Rate for Payer: Anthem Medicaid $114.43
Rate for Payer: Anthem Medicare Advantage/PPO $114.43
Rate for Payer: Anthem POS/PPO/Traditional $99.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $160.20
Rate for Payer: CareSource Just4Me Medicare $114.43
Rate for Payer: Cash Price $62.00
Rate for Payer: Cash Price $62.00
Rate for Payer: Cigna Commercial $102.92
Rate for Payer: First Health Commercial $117.80
Rate for Payer: Humana Commercial $105.40
Rate for Payer: Humana KY Medicaid $114.43
Rate for Payer: Humana Medicare Advantage $114.43
Rate for Payer: Kentucky WC Medicaid $115.57
Rate for Payer: Medical Mutual Of Ohio HMO $101.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $91.51
Rate for Payer: Molina Healthcare Benefit Exchange $137.32
Rate for Payer: Molina Healthcare Medicaid $116.72
Rate for Payer: Ohio Health Choice Commercial $109.12
Rate for Payer: Ohio Health Group HMO $93.00
Rate for Payer: Ohio Health Group PPO Differential $24.80
Rate for Payer: Ohio Health Group PPO No Differential $16.12
Rate for Payer: Ohio Health Group PPO SOMC Employees $38.44
Rate for Payer: PHCS Commercial $119.04
Rate for Payer: United Healthcare All Payer $109.12
Service Code HCPCS G0480
Hospital Charge Code 30000104
Hospital Revenue Code 300
Min. Negotiated Rate $16.12
Max. Negotiated Rate $119.04
Rate for Payer: Aetna Commercial $95.48
Rate for Payer: Anthem POS/PPO/Traditional $99.57
Rate for Payer: Cash Price $62.00
Rate for Payer: Cigna Commercial $102.92
Rate for Payer: First Health Commercial $117.80
Rate for Payer: Humana Commercial $105.40
Rate for Payer: Medical Mutual Of Ohio HMO $101.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $91.51
Rate for Payer: Molina Healthcare Benefit Exchange $37.20
Rate for Payer: Ohio Health Choice Commercial $109.12
Rate for Payer: Ohio Health Group HMO $93.00
Rate for Payer: Ohio Health Group PPO Differential $24.80
Rate for Payer: Ohio Health Group PPO No Differential $16.12
Rate for Payer: Ohio Health Group PPO SOMC Employees $38.44
Rate for Payer: PHCS Commercial $119.04
Rate for Payer: United Healthcare All Payer $109.12
Service Code HCPCS 84260
Hospital Charge Code 30000509
Hospital Revenue Code 300
Min. Negotiated Rate $22.36
Max. Negotiated Rate $165.12
Rate for Payer: Aetna Commercial $132.44
Rate for Payer: Anthem Medicaid $30.98
Rate for Payer: Anthem Medicare Advantage/PPO $30.98
Rate for Payer: Anthem POS/PPO/Traditional $138.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $43.37
Rate for Payer: CareSource Just4Me Medicare $30.98
Rate for Payer: Cash Price $86.00
Rate for Payer: Cash Price $86.00
Rate for Payer: Cigna Commercial $142.76
Rate for Payer: First Health Commercial $163.40
Rate for Payer: Humana Commercial $146.20
Rate for Payer: Humana KY Medicaid $30.98
Rate for Payer: Humana Medicare Advantage $30.98
Rate for Payer: Kentucky WC Medicaid $31.29
Rate for Payer: Medical Mutual Of Ohio HMO $141.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $126.94
Rate for Payer: Molina Healthcare Benefit Exchange $37.18
Rate for Payer: Molina Healthcare Medicaid $31.60
Rate for Payer: Ohio Health Choice Commercial $151.36
Rate for Payer: Ohio Health Group HMO $129.00
Rate for Payer: Ohio Health Group PPO Differential $34.40
Rate for Payer: Ohio Health Group PPO No Differential $22.36
Rate for Payer: Ohio Health Group PPO SOMC Employees $53.32
Rate for Payer: PHCS Commercial $165.12
Rate for Payer: United Healthcare All Payer $151.36
Service Code HCPCS 84260
Hospital Charge Code 30000509
Hospital Revenue Code 300
Min. Negotiated Rate $22.36
Max. Negotiated Rate $165.12
Rate for Payer: Aetna Commercial $132.44
Rate for Payer: Anthem POS/PPO/Traditional $138.12
Rate for Payer: Cash Price $86.00
Rate for Payer: Cigna Commercial $142.76
Rate for Payer: First Health Commercial $163.40
Rate for Payer: Humana Commercial $146.20
Rate for Payer: Medical Mutual Of Ohio HMO $141.04
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $126.94
Rate for Payer: Molina Healthcare Benefit Exchange $51.60
Rate for Payer: Ohio Health Choice Commercial $151.36
Rate for Payer: Ohio Health Group HMO $129.00
Rate for Payer: Ohio Health Group PPO Differential $34.40
Rate for Payer: Ohio Health Group PPO No Differential $22.36
Rate for Payer: Ohio Health Group PPO SOMC Employees $53.32
Rate for Payer: PHCS Commercial $165.12
Rate for Payer: United Healthcare All Payer $151.36
Service Code HCPCS 86022
Hospital Charge Code 30000973
Hospital Revenue Code 300
Min. Negotiated Rate $18.37
Max. Negotiated Rate $469.44
Rate for Payer: Aetna Commercial $376.53
Rate for Payer: Anthem Medicaid $18.37
Rate for Payer: Anthem Medicare Advantage/PPO $18.37
Rate for Payer: Anthem POS/PPO/Traditional $392.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $25.72
Rate for Payer: CareSource Just4Me Medicare $18.37
Rate for Payer: Cash Price $244.50
Rate for Payer: Cash Price $244.50
Rate for Payer: Cigna Commercial $405.87
Rate for Payer: First Health Commercial $464.55
Rate for Payer: Humana Commercial $415.65
Rate for Payer: Humana KY Medicaid $18.37
Rate for Payer: Humana Medicare Advantage $18.37
Rate for Payer: Kentucky WC Medicaid $18.55
Rate for Payer: Medical Mutual Of Ohio HMO $400.98
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $360.88
Rate for Payer: Molina Healthcare Benefit Exchange $22.04
Rate for Payer: Molina Healthcare Medicaid $18.74
Rate for Payer: Ohio Health Choice Commercial $430.32
Rate for Payer: Ohio Health Group HMO $366.75
Rate for Payer: Ohio Health Group PPO Differential $97.80
Rate for Payer: Ohio Health Group PPO No Differential $63.57
Rate for Payer: Ohio Health Group PPO SOMC Employees $151.59
Rate for Payer: PHCS Commercial $469.44
Rate for Payer: United Healthcare All Payer $430.32
Service Code HCPCS 86022
Hospital Charge Code 30000973
Hospital Revenue Code 300
Min. Negotiated Rate $63.57
Max. Negotiated Rate $469.44
Rate for Payer: Aetna Commercial $376.53
Rate for Payer: Anthem POS/PPO/Traditional $392.67
Rate for Payer: Cash Price $244.50
Rate for Payer: Cigna Commercial $405.87
Rate for Payer: First Health Commercial $464.55
Rate for Payer: Humana Commercial $415.65
Rate for Payer: Medical Mutual Of Ohio HMO $400.98
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $360.88
Rate for Payer: Molina Healthcare Benefit Exchange $146.70
Rate for Payer: Ohio Health Choice Commercial $430.32
Rate for Payer: Ohio Health Group HMO $366.75
Rate for Payer: Ohio Health Group PPO Differential $97.80
Rate for Payer: Ohio Health Group PPO No Differential $63.57
Rate for Payer: Ohio Health Group PPO SOMC Employees $151.59
Rate for Payer: PHCS Commercial $469.44
Rate for Payer: United Healthcare All Payer $430.32