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Service Code HCPCS 97022
Hospital Charge Code 43000007
Hospital Revenue Code 431
Min. Negotiated Rate $19.37
Max. Negotiated Rate $143.04
Rate for Payer: Aetna Commercial $114.73
Rate for Payer: Anthem Medicaid $51.24
Rate for Payer: Anthem POS/PPO/Traditional $116.22
Rate for Payer: Cash Price $74.50
Rate for Payer: Cigna Commercial $123.67
Rate for Payer: First Health Commercial $141.55
Rate for Payer: Humana Commercial $126.65
Rate for Payer: Humana KY Medicaid $51.24
Rate for Payer: Kentucky WC Medicaid $51.76
Rate for Payer: Medical Mutual Of Ohio HMO $122.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $109.96
Rate for Payer: Molina Healthcare Benefit Exchange $44.70
Rate for Payer: Molina Healthcare Medicaid $52.27
Rate for Payer: Ohio Health Choice Commercial $131.12
Rate for Payer: Ohio Health Group HMO $111.75
Rate for Payer: Ohio Health Group PPO Differential $29.80
Rate for Payer: Ohio Health Group PPO No Differential $19.37
Rate for Payer: Ohio Health Group PPO SOMC Employees $46.19
Rate for Payer: PHCS Commercial $143.04
Rate for Payer: United Healthcare All Payer $131.12
Service Code HCPCS 59430
Hospital Charge Code 72000021
Hospital Revenue Code 720
Min. Negotiated Rate $55.25
Max. Negotiated Rate $408.00
Rate for Payer: Aetna Commercial $327.25
Rate for Payer: Anthem Medicaid $146.16
Rate for Payer: Anthem POS/PPO/Traditional $331.50
Rate for Payer: Cash Price $212.50
Rate for Payer: Cigna Commercial $352.75
Rate for Payer: First Health Commercial $403.75
Rate for Payer: Humana Commercial $361.25
Rate for Payer: Humana KY Medicaid $146.16
Rate for Payer: Kentucky WC Medicaid $147.64
Rate for Payer: Medical Mutual Of Ohio HMO $348.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $313.65
Rate for Payer: Molina Healthcare Benefit Exchange $127.50
Rate for Payer: Molina Healthcare Medicaid $149.09
Rate for Payer: Ohio Health Choice Commercial $374.00
Rate for Payer: Ohio Health Group HMO $318.75
Rate for Payer: Ohio Health Group PPO Differential $85.00
Rate for Payer: Ohio Health Group PPO No Differential $55.25
Rate for Payer: Ohio Health Group PPO SOMC Employees $131.75
Rate for Payer: PHCS Commercial $408.00
Rate for Payer: United Healthcare All Payer $374.00
Service Code HCPCS 59430
Hospital Charge Code 72000021
Hospital Revenue Code 720
Min. Negotiated Rate $55.25
Max. Negotiated Rate $408.00
Rate for Payer: Aetna Commercial $327.25
Rate for Payer: Anthem POS/PPO/Traditional $331.50
Rate for Payer: Cash Price $212.50
Rate for Payer: Cigna Commercial $352.75
Rate for Payer: First Health Commercial $403.75
Rate for Payer: Humana Commercial $361.25
Rate for Payer: Medical Mutual Of Ohio HMO $348.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $313.65
Rate for Payer: Molina Healthcare Benefit Exchange $127.50
Rate for Payer: Ohio Health Choice Commercial $374.00
Rate for Payer: Ohio Health Group HMO $318.75
Rate for Payer: Ohio Health Group PPO Differential $85.00
Rate for Payer: Ohio Health Group PPO No Differential $55.25
Rate for Payer: Ohio Health Group PPO SOMC Employees $131.75
Rate for Payer: PHCS Commercial $408.00
Rate for Payer: United Healthcare All Payer $374.00
Service Code HCPCS 59430
Hospital Charge Code 72000021
Hospital Revenue Code 720
Min. Negotiated Rate $65.78
Max. Negotiated Rate $425.00
Rate for Payer: Aetna Commercial $210.86
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $92.05
Rate for Payer: Anthem Medicaid $65.78
Rate for Payer: Buckeye Medicare Advantage $425.00
Rate for Payer: Cash Price $212.50
Rate for Payer: Cash Price $212.50
Rate for Payer: Cigna Commercial $212.72
Rate for Payer: Healthspan PPO $167.32
Rate for Payer: Humana Medicaid $65.78
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $237.56
Rate for Payer: Molina Healthcare CHIP/Medicaid $67.10
Rate for Payer: Molina Healthcare Passport $65.78
Rate for Payer: Multiplan PHCS $255.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $297.50
Rate for Payer: UHCCP Medicaid $96.65
Rate for Payer: Wellcare CHIP/Medicaid $66.44
Service Code HCPCS 59430
Hospital Charge Code 720P0021
Hospital Revenue Code 720
Min. Negotiated Rate $65.78
Max. Negotiated Rate $425.00
Rate for Payer: Aetna Commercial $210.86
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $92.05
Rate for Payer: Anthem Medicaid $65.78
Rate for Payer: Buckeye Medicare Advantage $425.00
Rate for Payer: Cash Price $212.50
Rate for Payer: Cash Price $212.50
Rate for Payer: Cigna Commercial $212.72
Rate for Payer: Healthspan PPO $167.32
Rate for Payer: Humana Medicaid $65.78
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $237.56
Rate for Payer: Molina Healthcare CHIP/Medicaid $67.10
Rate for Payer: Molina Healthcare Passport $65.78
Rate for Payer: Multiplan PHCS $255.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $297.50
Rate for Payer: UHCCP Medicaid $96.65
Rate for Payer: Wellcare CHIP/Medicaid $66.44
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem Medicaid $1,117.68
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Humana KY Medicaid $1,117.68
Rate for Payer: Kentucky WC Medicaid $1,129.05
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Molina Healthcare Medicaid $1,140.10
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem Medicaid $1,117.68
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Humana KY Medicaid $1,117.68
Rate for Payer: Kentucky WC Medicaid $1,129.05
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Molina Healthcare Medicaid $1,140.10
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem Medicaid $1,117.68
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Humana KY Medicaid $1,117.68
Rate for Payer: Kentucky WC Medicaid $1,129.05
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Molina Healthcare Medicaid $1,140.10
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $3,120.00
Rate for Payer: Aetna Commercial $2,502.50
Rate for Payer: Anthem Medicaid $1,117.68
Rate for Payer: Anthem POS/PPO/Traditional $2,535.00
Rate for Payer: Cash Price $1,625.00
Rate for Payer: Cigna Commercial $2,697.50
Rate for Payer: First Health Commercial $3,087.50
Rate for Payer: Humana Commercial $2,762.50
Rate for Payer: Humana KY Medicaid $1,117.68
Rate for Payer: Kentucky WC Medicaid $1,129.05
Rate for Payer: Medical Mutual Of Ohio HMO $2,665.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,398.50
Rate for Payer: Molina Healthcare Benefit Exchange $975.00
Rate for Payer: Molina Healthcare Medicaid $1,140.10
Rate for Payer: Ohio Health Choice Commercial $2,860.00
Rate for Payer: Ohio Health Group HMO $2,437.50
Rate for Payer: Ohio Health Group PPO Differential $650.00
Rate for Payer: Ohio Health Group PPO No Differential $422.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,007.50
Rate for Payer: PHCS Commercial $3,120.00
Rate for Payer: United Healthcare All Payer $2,860.00
Service Code HCPCS 87177
Hospital Charge Code 30001316
Hospital Revenue Code 300
Min. Negotiated Rate $8.90
Max. Negotiated Rate $129.60
Rate for Payer: Aetna Commercial $103.95
Rate for Payer: Anthem Medicaid $8.90
Rate for Payer: Anthem Medicare Advantage/PPO $8.90
Rate for Payer: Anthem POS/PPO/Traditional $108.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $12.46
Rate for Payer: CareSource Just4Me Medicare $8.90
Rate for Payer: Cash Price $67.50
Rate for Payer: Cash Price $67.50
Rate for Payer: Cigna Commercial $112.05
Rate for Payer: First Health Commercial $128.25
Rate for Payer: Humana Commercial $114.75
Rate for Payer: Humana KY Medicaid $8.90
Rate for Payer: Humana Medicare Advantage $8.90
Rate for Payer: Kentucky WC Medicaid $8.99
Rate for Payer: Medical Mutual Of Ohio HMO $110.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $99.63
Rate for Payer: Molina Healthcare Benefit Exchange $10.68
Rate for Payer: Molina Healthcare Medicaid $9.08
Rate for Payer: Ohio Health Choice Commercial $118.80
Rate for Payer: Ohio Health Group HMO $101.25
Rate for Payer: Ohio Health Group PPO Differential $27.00
Rate for Payer: Ohio Health Group PPO No Differential $17.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $41.85
Rate for Payer: PHCS Commercial $129.60
Rate for Payer: United Healthcare All Payer $118.80
Service Code HCPCS 87177
Hospital Charge Code 30001316
Hospital Revenue Code 300
Min. Negotiated Rate $17.55
Max. Negotiated Rate $129.60
Rate for Payer: Aetna Commercial $103.95
Rate for Payer: Anthem POS/PPO/Traditional $108.40
Rate for Payer: Cash Price $67.50
Rate for Payer: Cigna Commercial $112.05
Rate for Payer: First Health Commercial $128.25
Rate for Payer: Humana Commercial $114.75
Rate for Payer: Medical Mutual Of Ohio HMO $110.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $99.63
Rate for Payer: Molina Healthcare Benefit Exchange $40.50
Rate for Payer: Ohio Health Choice Commercial $118.80
Rate for Payer: Ohio Health Group HMO $101.25
Rate for Payer: Ohio Health Group PPO Differential $27.00
Rate for Payer: Ohio Health Group PPO No Differential $17.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $41.85
Rate for Payer: PHCS Commercial $129.60
Rate for Payer: United Healthcare All Payer $118.80
Service Code HCPCS 58925
Hospital Charge Code 76102262
Hospital Revenue Code 761
Min. Negotiated Rate $260.00
Max. Negotiated Rate $1,920.00
Rate for Payer: Aetna Commercial $1,540.00
Rate for Payer: Anthem POS/PPO/Traditional $1,560.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,660.00
Rate for Payer: First Health Commercial $1,900.00
Rate for Payer: Humana Commercial $1,700.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,640.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,476.00
Rate for Payer: Molina Healthcare Benefit Exchange $600.00
Rate for Payer: Ohio Health Choice Commercial $1,760.00
Rate for Payer: Ohio Health Group HMO $1,500.00
Rate for Payer: Ohio Health Group PPO Differential $400.00
Rate for Payer: Ohio Health Group PPO No Differential $260.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $620.00
Rate for Payer: PHCS Commercial $1,920.00
Rate for Payer: United Healthcare All Payer $1,760.00
Service Code HCPCS 58925
Hospital Charge Code 76102262
Hospital Revenue Code 761
Min. Negotiated Rate $260.00
Max. Negotiated Rate $6,021.69
Rate for Payer: Aetna Commercial $1,540.00
Rate for Payer: Anthem Medicaid $687.80
Rate for Payer: Anthem Medicare Advantage/PPO $4,301.21
Rate for Payer: Anthem POS/PPO/Traditional $1,560.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $6,021.69
Rate for Payer: CareSource Just4Me Medicare $5,806.63
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,660.00
Rate for Payer: First Health Commercial $1,900.00
Rate for Payer: Humana Commercial $1,700.00
Rate for Payer: Humana KY Medicaid $687.80
Rate for Payer: Humana Medicare Advantage $4,301.21
Rate for Payer: Kentucky WC Medicaid $694.80
Rate for Payer: Medical Mutual Of Ohio HMO $1,640.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,476.00
Rate for Payer: Molina Healthcare Benefit Exchange $5,161.45
Rate for Payer: Molina Healthcare Medicaid $701.60
Rate for Payer: Ohio Health Choice Commercial $1,760.00
Rate for Payer: Ohio Health Group HMO $1,500.00
Rate for Payer: Ohio Health Group PPO Differential $400.00
Rate for Payer: Ohio Health Group PPO No Differential $260.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $620.00
Rate for Payer: PHCS Commercial $1,920.00
Rate for Payer: United Healthcare All Payer $1,760.00
Service Code HCPCS 58925
Hospital Charge Code 76102262
Hospital Revenue Code 761
Min. Negotiated Rate $397.28
Max. Negotiated Rate $2,000.00
Rate for Payer: Aetna Commercial $1,108.15
Rate for Payer: Anthem Medicaid $397.28
Rate for Payer: Buckeye Medicare Advantage $2,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,069.56
Rate for Payer: Healthspan PPO $1,072.97
Rate for Payer: Humana Medicaid $397.28
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $960.06
Rate for Payer: Molina Healthcare CHIP/Medicaid $405.23
Rate for Payer: Molina Healthcare Passport $397.28
Rate for Payer: Multiplan PHCS $1,200.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,400.00
Rate for Payer: UHCCP Medicaid $700.00
Rate for Payer: Wellcare CHIP/Medicaid $401.25
Service Code HCPCS 58925
Hospital Charge Code 761P2262
Hospital Revenue Code 761
Min. Negotiated Rate $397.28
Max. Negotiated Rate $2,000.00
Rate for Payer: Aetna Commercial $1,108.15
Rate for Payer: Anthem Medicaid $397.28
Rate for Payer: Buckeye Medicare Advantage $2,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,069.56
Rate for Payer: Healthspan PPO $1,072.97
Rate for Payer: Humana Medicaid $397.28
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $960.06
Rate for Payer: Molina Healthcare CHIP/Medicaid $405.23
Rate for Payer: Molina Healthcare Passport $397.28
Rate for Payer: Multiplan PHCS $1,200.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,400.00
Rate for Payer: UHCCP Medicaid $700.00
Rate for Payer: Wellcare CHIP/Medicaid $401.25
Service Code HCPCS 94762
Hospital Charge Code 46000018
Hospital Revenue Code 460
Min. Negotiated Rate $35.62
Max. Negotiated Rate $263.04
Rate for Payer: Aetna Commercial $210.98
Rate for Payer: Anthem Medicaid $94.23
Rate for Payer: Anthem Medicare Advantage/PPO $135.08
Rate for Payer: Anthem POS/PPO/Traditional $213.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $189.11
Rate for Payer: CareSource Just4Me Medicare $182.36
Rate for Payer: Cash Price $137.00
Rate for Payer: Cash Price $137.00
Rate for Payer: Cigna Commercial $227.42
Rate for Payer: First Health Commercial $260.30
Rate for Payer: Humana Commercial $232.90
Rate for Payer: Humana KY Medicaid $94.23
Rate for Payer: Humana Medicare Advantage $135.08
Rate for Payer: Kentucky WC Medicaid $95.19
Rate for Payer: Medical Mutual Of Ohio HMO $224.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $202.21
Rate for Payer: Molina Healthcare Benefit Exchange $162.10
Rate for Payer: Molina Healthcare Medicaid $96.12
Rate for Payer: Ohio Health Choice Commercial $241.12
Rate for Payer: Ohio Health Group HMO $205.50
Rate for Payer: Ohio Health Group PPO Differential $54.80
Rate for Payer: Ohio Health Group PPO No Differential $35.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $84.94
Rate for Payer: PHCS Commercial $263.04
Rate for Payer: United Healthcare All Payer $241.12
Service Code HCPCS 94762
Hospital Charge Code 46000018
Hospital Revenue Code 460
Min. Negotiated Rate $35.62
Max. Negotiated Rate $263.04
Rate for Payer: Aetna Commercial $210.98
Rate for Payer: Anthem POS/PPO/Traditional $213.72
Rate for Payer: Cash Price $137.00
Rate for Payer: Cigna Commercial $227.42
Rate for Payer: First Health Commercial $260.30
Rate for Payer: Humana Commercial $232.90
Rate for Payer: Medical Mutual Of Ohio HMO $224.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $202.21
Rate for Payer: Molina Healthcare Benefit Exchange $82.20
Rate for Payer: Ohio Health Choice Commercial $241.12
Rate for Payer: Ohio Health Group HMO $205.50
Rate for Payer: Ohio Health Group PPO Differential $54.80
Rate for Payer: Ohio Health Group PPO No Differential $35.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $84.94
Rate for Payer: PHCS Commercial $263.04
Rate for Payer: United Healthcare All Payer $241.12
Service Code NDC 17772012101
Hospital Charge Code 25004003
Hospital Revenue Code 250
Min. Negotiated Rate $3.38
Max. Negotiated Rate $24.99
Rate for Payer: Aetna Commercial $20.04
Rate for Payer: Anthem Medicaid $8.95
Rate for Payer: Anthem POS/PPO/Traditional $20.30
Rate for Payer: Cash Price $13.02
Rate for Payer: Cigna Commercial $21.60
Rate for Payer: First Health Commercial $24.73
Rate for Payer: Humana Commercial $22.13
Rate for Payer: Humana KY Medicaid $8.95
Rate for Payer: Kentucky WC Medicaid $9.04
Rate for Payer: Medical Mutual Of Ohio HMO $21.34
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $19.21
Rate for Payer: Molina Healthcare Benefit Exchange $7.81
Rate for Payer: Molina Healthcare Medicaid $9.13
Rate for Payer: Ohio Health Choice Commercial $22.91
Rate for Payer: Ohio Health Group HMO $19.52
Rate for Payer: Ohio Health Group PPO Differential $5.21
Rate for Payer: Ohio Health Group PPO No Differential $3.38
Rate for Payer: Ohio Health Group PPO SOMC Employees $8.07
Rate for Payer: PHCS Commercial $24.99
Rate for Payer: United Healthcare All Payer $22.91
Service Code NDC 17772012101
Hospital Charge Code 25004003
Hospital Revenue Code 250
Min. Negotiated Rate $3.38
Max. Negotiated Rate $24.99
Rate for Payer: Aetna Commercial $20.04
Rate for Payer: Anthem POS/PPO/Traditional $20.30
Rate for Payer: Cash Price $13.02
Rate for Payer: Cigna Commercial $21.60
Rate for Payer: First Health Commercial $24.73
Rate for Payer: Humana Commercial $22.13
Rate for Payer: Medical Mutual Of Ohio HMO $21.34
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $19.21
Rate for Payer: Molina Healthcare Benefit Exchange $7.81
Rate for Payer: Ohio Health Choice Commercial $22.91
Rate for Payer: Ohio Health Group HMO $19.52
Rate for Payer: Ohio Health Group PPO Differential $5.21
Rate for Payer: Ohio Health Group PPO No Differential $3.38
Rate for Payer: Ohio Health Group PPO SOMC Employees $8.07
Rate for Payer: PHCS Commercial $24.99
Rate for Payer: United Healthcare All Payer $22.91
Service Code NDC 17772012201
Hospital Charge Code 25004004
Hospital Revenue Code 250
Min. Negotiated Rate $3.84
Max. Negotiated Rate $28.36
Rate for Payer: Aetna Commercial $22.75
Rate for Payer: Anthem Medicaid $10.16
Rate for Payer: Anthem POS/PPO/Traditional $23.04
Rate for Payer: Cash Price $14.77
Rate for Payer: Cigna Commercial $24.52
Rate for Payer: First Health Commercial $28.06
Rate for Payer: Humana Commercial $25.11
Rate for Payer: Humana KY Medicaid $10.16
Rate for Payer: Kentucky WC Medicaid $10.26
Rate for Payer: Medical Mutual Of Ohio HMO $24.22
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $21.80
Rate for Payer: Molina Healthcare Benefit Exchange $8.86
Rate for Payer: Molina Healthcare Medicaid $10.36
Rate for Payer: Ohio Health Choice Commercial $26.00
Rate for Payer: Ohio Health Group HMO $22.16
Rate for Payer: Ohio Health Group PPO Differential $5.91
Rate for Payer: Ohio Health Group PPO No Differential $3.84
Rate for Payer: Ohio Health Group PPO SOMC Employees $9.16
Rate for Payer: PHCS Commercial $28.36
Rate for Payer: United Healthcare All Payer $26.00
Service Code NDC 17772012201
Hospital Charge Code 25004004
Hospital Revenue Code 250
Min. Negotiated Rate $3.84
Max. Negotiated Rate $28.36
Rate for Payer: Aetna Commercial $22.75
Rate for Payer: Anthem POS/PPO/Traditional $23.04
Rate for Payer: Cash Price $14.77
Rate for Payer: Cigna Commercial $24.52
Rate for Payer: First Health Commercial $28.06
Rate for Payer: Humana Commercial $25.11
Rate for Payer: Medical Mutual Of Ohio HMO $24.22
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $21.80
Rate for Payer: Molina Healthcare Benefit Exchange $8.86
Rate for Payer: Ohio Health Choice Commercial $26.00
Rate for Payer: Ohio Health Group HMO $22.16
Rate for Payer: Ohio Health Group PPO Differential $5.91
Rate for Payer: Ohio Health Group PPO No Differential $3.84
Rate for Payer: Ohio Health Group PPO SOMC Employees $9.16
Rate for Payer: PHCS Commercial $28.36
Rate for Payer: United Healthcare All Payer $26.00