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Service Code NDC 17772012301
Hospital Charge Code 25004005
Hospital Revenue Code 250
Min. Negotiated Rate $5.20
Max. Negotiated Rate $38.37
Rate for Payer: Aetna Commercial $30.78
Rate for Payer: Anthem Medicaid $13.75
Rate for Payer: Anthem POS/PPO/Traditional $31.18
Rate for Payer: Cash Price $19.98
Rate for Payer: Cigna Commercial $33.18
Rate for Payer: First Health Commercial $37.97
Rate for Payer: Humana Commercial $33.97
Rate for Payer: Humana KY Medicaid $13.75
Rate for Payer: Kentucky WC Medicaid $13.89
Rate for Payer: Medical Mutual Of Ohio HMO $32.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $29.50
Rate for Payer: Molina Healthcare Benefit Exchange $11.99
Rate for Payer: Molina Healthcare Medicaid $14.02
Rate for Payer: Ohio Health Choice Commercial $35.17
Rate for Payer: Ohio Health Group HMO $29.98
Rate for Payer: Ohio Health Group PPO Differential $7.99
Rate for Payer: Ohio Health Group PPO No Differential $5.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $12.39
Rate for Payer: PHCS Commercial $38.37
Rate for Payer: United Healthcare All Payer $35.17
Service Code NDC 17772012301
Hospital Charge Code 25004005
Hospital Revenue Code 250
Min. Negotiated Rate $5.20
Max. Negotiated Rate $38.37
Rate for Payer: Aetna Commercial $30.78
Rate for Payer: Anthem POS/PPO/Traditional $31.18
Rate for Payer: Cash Price $19.98
Rate for Payer: Cigna Commercial $33.18
Rate for Payer: First Health Commercial $37.97
Rate for Payer: Humana Commercial $33.97
Rate for Payer: Medical Mutual Of Ohio HMO $32.78
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $29.50
Rate for Payer: Molina Healthcare Benefit Exchange $11.99
Rate for Payer: Ohio Health Choice Commercial $35.17
Rate for Payer: Ohio Health Group HMO $29.98
Rate for Payer: Ohio Health Group PPO Differential $7.99
Rate for Payer: Ohio Health Group PPO No Differential $5.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $12.39
Rate for Payer: PHCS Commercial $38.37
Rate for Payer: United Healthcare All Payer $35.17
Service Code NDC 70074054387
Hospital Charge Code 27000097
Hospital Revenue Code 270
Min. Negotiated Rate $9.62
Max. Negotiated Rate $71.04
Rate for Payer: Aetna Commercial $56.98
Rate for Payer: Anthem POS/PPO/Traditional $57.72
Rate for Payer: Cash Price $37.00
Rate for Payer: Cigna Commercial $61.42
Rate for Payer: First Health Commercial $70.30
Rate for Payer: Humana Commercial $62.90
Rate for Payer: Medical Mutual Of Ohio HMO $60.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $54.61
Rate for Payer: Molina Healthcare Benefit Exchange $22.20
Rate for Payer: Ohio Health Choice Commercial $65.12
Rate for Payer: Ohio Health Group HMO $55.50
Rate for Payer: Ohio Health Group PPO Differential $14.80
Rate for Payer: Ohio Health Group PPO No Differential $9.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $22.94
Rate for Payer: PHCS Commercial $71.04
Rate for Payer: United Healthcare All Payer $65.12
Service Code NDC 70074054387
Hospital Charge Code 27000097
Hospital Revenue Code 270
Min. Negotiated Rate $9.62
Max. Negotiated Rate $71.04
Rate for Payer: Aetna Commercial $56.98
Rate for Payer: Anthem Medicaid $25.45
Rate for Payer: Anthem POS/PPO/Traditional $57.72
Rate for Payer: Cash Price $37.00
Rate for Payer: Cigna Commercial $61.42
Rate for Payer: First Health Commercial $70.30
Rate for Payer: Humana Commercial $62.90
Rate for Payer: Humana KY Medicaid $25.45
Rate for Payer: Kentucky WC Medicaid $25.71
Rate for Payer: Medical Mutual Of Ohio HMO $60.68
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $54.61
Rate for Payer: Molina Healthcare Benefit Exchange $22.20
Rate for Payer: Molina Healthcare Medicaid $25.96
Rate for Payer: Ohio Health Choice Commercial $65.12
Rate for Payer: Ohio Health Group HMO $55.50
Rate for Payer: Ohio Health Group PPO Differential $14.80
Rate for Payer: Ohio Health Group PPO No Differential $9.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $22.94
Rate for Payer: PHCS Commercial $71.04
Rate for Payer: United Healthcare All Payer $65.12
Service Code NDC 70074062717
Hospital Charge Code 25001147
Hospital Revenue Code 250
Min. Negotiated Rate $13.78
Max. Negotiated Rate $101.76
Rate for Payer: Aetna Commercial $81.62
Rate for Payer: Anthem Medicaid $36.45
Rate for Payer: Anthem POS/PPO/Traditional $82.68
Rate for Payer: Cash Price $53.00
Rate for Payer: Cigna Commercial $87.98
Rate for Payer: First Health Commercial $100.70
Rate for Payer: Humana Commercial $90.10
Rate for Payer: Humana KY Medicaid $36.45
Rate for Payer: Kentucky WC Medicaid $36.82
Rate for Payer: Medical Mutual Of Ohio HMO $86.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $78.23
Rate for Payer: Molina Healthcare Benefit Exchange $31.80
Rate for Payer: Molina Healthcare Medicaid $37.18
Rate for Payer: Ohio Health Choice Commercial $93.28
Rate for Payer: Ohio Health Group HMO $79.50
Rate for Payer: Ohio Health Group PPO Differential $21.20
Rate for Payer: Ohio Health Group PPO No Differential $13.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $32.86
Rate for Payer: PHCS Commercial $101.76
Rate for Payer: United Healthcare All Payer $93.28
Service Code NDC 70074062717
Hospital Charge Code 25001147
Hospital Revenue Code 250
Min. Negotiated Rate $13.78
Max. Negotiated Rate $101.76
Rate for Payer: Aetna Commercial $81.62
Rate for Payer: Anthem POS/PPO/Traditional $82.68
Rate for Payer: Cash Price $53.00
Rate for Payer: Cigna Commercial $87.98
Rate for Payer: First Health Commercial $100.70
Rate for Payer: Humana Commercial $90.10
Rate for Payer: Medical Mutual Of Ohio HMO $86.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $78.23
Rate for Payer: Molina Healthcare Benefit Exchange $31.80
Rate for Payer: Ohio Health Choice Commercial $93.28
Rate for Payer: Ohio Health Group HMO $79.50
Rate for Payer: Ohio Health Group PPO Differential $21.20
Rate for Payer: Ohio Health Group PPO No Differential $13.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $32.86
Rate for Payer: PHCS Commercial $101.76
Rate for Payer: United Healthcare All Payer $93.28
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem Medicaid $4,314.38
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Humana KY Medicaid $4,314.38
Rate for Payer: Kentucky WC Medicaid $4,358.29
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Molina Healthcare Medicaid $4,400.94
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,630.91
Max. Negotiated Rate $12,043.63
Rate for Payer: Aetna Commercial $9,660.00
Rate for Payer: Anthem POS/PPO/Traditional $9,785.45
Rate for Payer: Cash Price $6,272.73
Rate for Payer: Cigna Commercial $10,412.72
Rate for Payer: First Health Commercial $11,918.18
Rate for Payer: Humana Commercial $10,663.63
Rate for Payer: Medical Mutual Of Ohio HMO $10,287.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,258.54
Rate for Payer: Molina Healthcare Benefit Exchange $3,763.64
Rate for Payer: Ohio Health Choice Commercial $11,040.00
Rate for Payer: Ohio Health Group HMO $9,409.09
Rate for Payer: Ohio Health Group PPO Differential $2,509.09
Rate for Payer: Ohio Health Group PPO No Differential $1,630.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,889.09
Rate for Payer: PHCS Commercial $12,043.63
Rate for Payer: United Healthcare All Payer $11,040.00
Service Code HCPCS 94761
Hospital Charge Code 46000017
Hospital Revenue Code 460
Min. Negotiated Rate $5.40
Max. Negotiated Rate $301.00
Rate for Payer: Aetna Commercial $9.62
Rate for Payer: Anthem Medicaid $18.62
Rate for Payer: Buckeye Medicare Advantage $301.00
Rate for Payer: Cash Price $150.50
Rate for Payer: Cash Price $150.50
Rate for Payer: Cigna Commercial $7.82
Rate for Payer: Healthspan PPO $7.45
Rate for Payer: Humana Medicaid $18.62
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $5.40
Rate for Payer: Molina Healthcare CHIP/Medicaid $18.99
Rate for Payer: Molina Healthcare Passport $18.62
Rate for Payer: Multiplan PHCS $180.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $210.70
Rate for Payer: UHCCP Medicaid $105.35
Rate for Payer: Wellcare CHIP/Medicaid $18.81