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Service Code HCPCS 69637
Hospital Charge Code 761P2432
Hospital Revenue Code 761
Min. Negotiated Rate $994.28
Max. Negotiated Rate $3,400.00
Rate for Payer: Aetna Commercial $1,952.82
Rate for Payer: Anthem Medicaid $994.28
Rate for Payer: Buckeye Medicare Advantage $3,400.00
Rate for Payer: Cash Price $1,700.00
Rate for Payer: Cash Price $1,700.00
Rate for Payer: Cigna Commercial $1,950.28
Rate for Payer: Healthspan PPO $1,732.24
Rate for Payer: Humana Medicaid $994.28
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,754.46
Rate for Payer: Molina Healthcare CHIP/Medicaid $1,014.17
Rate for Payer: Molina Healthcare Passport $994.28
Rate for Payer: Multiplan PHCS $2,040.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,380.00
Rate for Payer: UHCCP Medicaid $1,190.00
Rate for Payer: Wellcare CHIP/Medicaid $1,004.22
Service Code HCPCS 69310
Hospital Charge Code 76102416
Hospital Revenue Code 761
Min. Negotiated Rate $600.92
Max. Negotiated Rate $2,600.00
Rate for Payer: Aetna Commercial $1,525.04
Rate for Payer: Anthem Medicaid $600.92
Rate for Payer: Buckeye Medicare Advantage $2,600.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cigna Commercial $1,534.11
Rate for Payer: Healthspan PPO $1,352.78
Rate for Payer: Humana Medicaid $600.92
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,378.86
Rate for Payer: Molina Healthcare CHIP/Medicaid $612.94
Rate for Payer: Molina Healthcare Passport $600.92
Rate for Payer: Multiplan PHCS $1,560.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,820.00
Rate for Payer: UHCCP Medicaid $910.00
Rate for Payer: Wellcare CHIP/Medicaid $606.93
Service Code HCPCS 69310
Hospital Charge Code 76102416
Hospital Revenue Code 761
Min. Negotiated Rate $338.00
Max. Negotiated Rate $2,496.00
Rate for Payer: Aetna Commercial $2,002.00
Rate for Payer: Anthem POS/PPO/Traditional $2,028.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cigna Commercial $2,158.00
Rate for Payer: First Health Commercial $2,470.00
Rate for Payer: Humana Commercial $2,210.00
Rate for Payer: Medical Mutual Of Ohio HMO $2,132.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,918.80
Rate for Payer: Molina Healthcare Benefit Exchange $780.00
Rate for Payer: Ohio Health Choice Commercial $2,288.00
Rate for Payer: Ohio Health Group HMO $1,950.00
Rate for Payer: Ohio Health Group PPO Differential $520.00
Rate for Payer: Ohio Health Group PPO No Differential $338.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $806.00
Rate for Payer: PHCS Commercial $2,496.00
Rate for Payer: United Healthcare All Payer $2,288.00
Service Code HCPCS 69310
Hospital Charge Code 76102416
Hospital Revenue Code 761
Min. Negotiated Rate $338.00
Max. Negotiated Rate $7,089.80
Rate for Payer: Aetna Commercial $2,002.00
Rate for Payer: Anthem Medicaid $894.14
Rate for Payer: Anthem Medicare Advantage/PPO $5,064.14
Rate for Payer: Anthem POS/PPO/Traditional $2,028.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $7,089.80
Rate for Payer: CareSource Just4Me Medicare $6,836.59
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cigna Commercial $2,158.00
Rate for Payer: First Health Commercial $2,470.00
Rate for Payer: Humana Commercial $2,210.00
Rate for Payer: Humana KY Medicaid $894.14
Rate for Payer: Humana Medicare Advantage $5,064.14
Rate for Payer: Kentucky WC Medicaid $903.24
Rate for Payer: Medical Mutual Of Ohio HMO $2,132.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,918.80
Rate for Payer: Molina Healthcare Benefit Exchange $6,076.97
Rate for Payer: Molina Healthcare Medicaid $912.08
Rate for Payer: Ohio Health Choice Commercial $2,288.00
Rate for Payer: Ohio Health Group HMO $1,950.00
Rate for Payer: Ohio Health Group PPO Differential $520.00
Rate for Payer: Ohio Health Group PPO No Differential $338.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $806.00
Rate for Payer: PHCS Commercial $2,496.00
Rate for Payer: United Healthcare All Payer $2,288.00
Service Code HCPCS 69310
Hospital Charge Code 761P2416
Hospital Revenue Code 761
Min. Negotiated Rate $600.92
Max. Negotiated Rate $2,600.00
Rate for Payer: Aetna Commercial $1,525.04
Rate for Payer: Anthem Medicaid $600.92
Rate for Payer: Buckeye Medicare Advantage $2,600.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cash Price $1,300.00
Rate for Payer: Cigna Commercial $1,534.11
Rate for Payer: Healthspan PPO $1,352.78
Rate for Payer: Humana Medicaid $600.92
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,378.86
Rate for Payer: Molina Healthcare CHIP/Medicaid $612.94
Rate for Payer: Molina Healthcare Passport $600.92
Rate for Payer: Multiplan PHCS $1,560.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,820.00
Rate for Payer: UHCCP Medicaid $910.00
Rate for Payer: Wellcare CHIP/Medicaid $606.93
Service Code HCPCS J3490
Hospital Charge Code 25003950
Hospital Revenue Code 636
Min. Negotiated Rate $110.18
Max. Negotiated Rate $813.60
Rate for Payer: Aetna Commercial $652.58
Rate for Payer: Anthem POS/PPO/Traditional $661.05
Rate for Payer: Cash Price $423.75
Rate for Payer: Cigna Commercial $703.42
Rate for Payer: First Health Commercial $805.12
Rate for Payer: Humana Commercial $720.38
Rate for Payer: Medical Mutual Of Ohio HMO $694.95
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $625.46
Rate for Payer: Molina Healthcare Benefit Exchange $254.25
Rate for Payer: Ohio Health Choice Commercial $745.80
Rate for Payer: Ohio Health Group HMO $635.62
Rate for Payer: Ohio Health Group PPO Differential $169.50
Rate for Payer: Ohio Health Group PPO No Differential $110.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $262.72
Rate for Payer: PHCS Commercial $813.60
Rate for Payer: United Healthcare All Payer $745.80
Service Code HCPCS J3490
Hospital Charge Code 25003950
Hospital Revenue Code 636
Min. Negotiated Rate $110.18
Max. Negotiated Rate $813.60
Rate for Payer: Aetna Commercial $652.58
Rate for Payer: Anthem Medicaid $291.46
Rate for Payer: Anthem POS/PPO/Traditional $661.05
Rate for Payer: Cash Price $423.75
Rate for Payer: Cigna Commercial $703.42
Rate for Payer: First Health Commercial $805.12
Rate for Payer: Humana Commercial $720.38
Rate for Payer: Humana KY Medicaid $291.46
Rate for Payer: Kentucky WC Medicaid $294.42
Rate for Payer: Medical Mutual Of Ohio HMO $694.95
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $625.46
Rate for Payer: Molina Healthcare Benefit Exchange $254.25
Rate for Payer: Molina Healthcare Medicaid $297.30
Rate for Payer: Ohio Health Choice Commercial $745.80
Rate for Payer: Ohio Health Group HMO $635.62
Rate for Payer: Ohio Health Group PPO Differential $169.50
Rate for Payer: Ohio Health Group PPO No Differential $110.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $262.72
Rate for Payer: PHCS Commercial $813.60
Rate for Payer: United Healthcare All Payer $745.80
Service Code HCPCS 35371
Hospital Charge Code 76101388
Hospital Revenue Code 761
Min. Negotiated Rate $704.10
Max. Negotiated Rate $2,500.00
Rate for Payer: Aetna Commercial $1,456.40
Rate for Payer: Anthem Medicaid $704.10
Rate for Payer: Buckeye Medicare Advantage $2,500.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cigna Commercial $1,405.40
Rate for Payer: Healthspan PPO $1,431.93
Rate for Payer: Humana Medicaid $704.10
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,127.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $718.18
Rate for Payer: Molina Healthcare Passport $704.10
Rate for Payer: Multiplan PHCS $1,500.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,750.00
Rate for Payer: UHCCP Medicaid $875.00
Rate for Payer: Wellcare CHIP/Medicaid $711.14
Service Code HCPCS 35371
Hospital Charge Code 76101388
Hospital Revenue Code 761
Min. Negotiated Rate $325.00
Max. Negotiated Rate $2,400.00
Rate for Payer: Aetna Commercial $1,925.00
Rate for Payer: Anthem POS/PPO/Traditional $1,950.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cigna Commercial $2,075.00
Rate for Payer: First Health Commercial $2,375.00
Rate for Payer: Humana Commercial $2,125.00
Rate for Payer: Medical Mutual Of Ohio HMO $2,050.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,845.00
Rate for Payer: Molina Healthcare Benefit Exchange $750.00
Rate for Payer: Ohio Health Choice Commercial $2,200.00
Rate for Payer: Ohio Health Group HMO $1,875.00
Rate for Payer: Ohio Health Group PPO Differential $500.00
Rate for Payer: Ohio Health Group PPO No Differential $325.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $775.00
Rate for Payer: PHCS Commercial $2,400.00
Rate for Payer: United Healthcare All Payer $2,200.00
Service Code HCPCS 35371
Hospital Charge Code 76101388
Hospital Revenue Code 761
Min. Negotiated Rate $325.00
Max. Negotiated Rate $2,400.00
Rate for Payer: Aetna Commercial $1,925.00
Rate for Payer: Anthem Medicaid $859.75
Rate for Payer: Anthem POS/PPO/Traditional $1,950.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cigna Commercial $2,075.00
Rate for Payer: First Health Commercial $2,375.00
Rate for Payer: Humana Commercial $2,125.00
Rate for Payer: Humana KY Medicaid $859.75
Rate for Payer: Kentucky WC Medicaid $868.50
Rate for Payer: Medical Mutual Of Ohio HMO $2,050.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,845.00
Rate for Payer: Molina Healthcare Benefit Exchange $750.00
Rate for Payer: Molina Healthcare Medicaid $877.00
Rate for Payer: Ohio Health Choice Commercial $2,200.00
Rate for Payer: Ohio Health Group HMO $1,875.00
Rate for Payer: Ohio Health Group PPO Differential $500.00
Rate for Payer: Ohio Health Group PPO No Differential $325.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $775.00
Rate for Payer: PHCS Commercial $2,400.00
Rate for Payer: United Healthcare All Payer $2,200.00
Service Code HCPCS 35371
Hospital Charge Code 761P1388
Hospital Revenue Code 761
Min. Negotiated Rate $704.10
Max. Negotiated Rate $2,500.00
Rate for Payer: Aetna Commercial $1,456.40
Rate for Payer: Anthem Medicaid $704.10
Rate for Payer: Buckeye Medicare Advantage $2,500.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cash Price $1,250.00
Rate for Payer: Cigna Commercial $1,405.40
Rate for Payer: Healthspan PPO $1,431.93
Rate for Payer: Humana Medicaid $704.10
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,127.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $718.18
Rate for Payer: Molina Healthcare Passport $704.10
Rate for Payer: Multiplan PHCS $1,500.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,750.00
Rate for Payer: UHCCP Medicaid $875.00
Rate for Payer: Wellcare CHIP/Medicaid $711.14
Service Code HCPCS J3489
Hospital Charge Code 25002455
Hospital Revenue Code 636
Min. Negotiated Rate $212.55
Max. Negotiated Rate $1,569.60
Rate for Payer: Aetna Commercial $1,258.95
Rate for Payer: Anthem POS/PPO/Traditional $1,275.30
Rate for Payer: Cash Price $817.50
Rate for Payer: Cigna Commercial $1,357.05
Rate for Payer: First Health Commercial $1,553.25
Rate for Payer: Humana Commercial $1,389.75
Rate for Payer: Medical Mutual Of Ohio HMO $1,340.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,206.63
Rate for Payer: Molina Healthcare Benefit Exchange $490.50
Rate for Payer: Ohio Health Choice Commercial $1,438.80
Rate for Payer: Ohio Health Group HMO $1,226.25
Rate for Payer: Ohio Health Group PPO Differential $327.00
Rate for Payer: Ohio Health Group PPO No Differential $212.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $506.85
Rate for Payer: PHCS Commercial $1,569.60
Rate for Payer: United Healthcare All Payer $1,438.80
Service Code HCPCS J3489
Hospital Charge Code 25002455
Hospital Revenue Code 636
Min. Negotiated Rate $212.55
Max. Negotiated Rate $1,569.60
Rate for Payer: Aetna Commercial $1,258.95
Rate for Payer: Anthem Medicaid $562.28
Rate for Payer: Anthem POS/PPO/Traditional $1,275.30
Rate for Payer: Cash Price $817.50
Rate for Payer: Cigna Commercial $1,357.05
Rate for Payer: First Health Commercial $1,553.25
Rate for Payer: Humana Commercial $1,389.75
Rate for Payer: Humana KY Medicaid $562.28
Rate for Payer: Kentucky WC Medicaid $568.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,340.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,206.63
Rate for Payer: Molina Healthcare Benefit Exchange $490.50
Rate for Payer: Molina Healthcare Medicaid $573.56
Rate for Payer: Ohio Health Choice Commercial $1,438.80
Rate for Payer: Ohio Health Group HMO $1,226.25
Rate for Payer: Ohio Health Group PPO Differential $327.00
Rate for Payer: Ohio Health Group PPO No Differential $212.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $506.85
Rate for Payer: PHCS Commercial $1,569.60
Rate for Payer: United Healthcare All Payer $1,438.80
Service Code HCPCS 90746
Hospital Charge Code 25000047
Hospital Revenue Code 636
Min. Negotiated Rate $23.81
Max. Negotiated Rate $175.83
Rate for Payer: Aetna Commercial $141.03
Rate for Payer: Anthem POS/PPO/Traditional $142.86
Rate for Payer: Cash Price $91.58
Rate for Payer: Cigna Commercial $152.02
Rate for Payer: First Health Commercial $174.00
Rate for Payer: Humana Commercial $155.69
Rate for Payer: Medical Mutual Of Ohio HMO $150.19
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $135.17
Rate for Payer: Molina Healthcare Benefit Exchange $54.95
Rate for Payer: Ohio Health Choice Commercial $161.18
Rate for Payer: Ohio Health Group HMO $137.37
Rate for Payer: Ohio Health Group PPO Differential $36.63
Rate for Payer: Ohio Health Group PPO No Differential $23.81
Rate for Payer: Ohio Health Group PPO SOMC Employees $56.78
Rate for Payer: PHCS Commercial $175.83
Rate for Payer: United Healthcare All Payer $161.18
Service Code HCPCS 90746
Hospital Charge Code 25000047
Hospital Revenue Code 636
Min. Negotiated Rate $23.81
Max. Negotiated Rate $175.83
Rate for Payer: Anthem Medicaid $62.99
Rate for Payer: Anthem POS/PPO/Traditional $142.86
Rate for Payer: Cash Price $91.58
Rate for Payer: Cigna Commercial $152.02
Rate for Payer: First Health Commercial $174.00
Rate for Payer: Humana Commercial $155.69
Rate for Payer: Humana KY Medicaid $62.99
Rate for Payer: Kentucky WC Medicaid $63.63
Rate for Payer: Medical Mutual Of Ohio HMO $150.19
Rate for Payer: Aetna Commercial $141.03
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $135.17
Rate for Payer: Molina Healthcare Benefit Exchange $54.95
Rate for Payer: Molina Healthcare Medicaid $64.25
Rate for Payer: Ohio Health Choice Commercial $161.18
Rate for Payer: Ohio Health Group HMO $137.37
Rate for Payer: Ohio Health Group PPO Differential $36.63
Rate for Payer: Ohio Health Group PPO No Differential $23.81
Rate for Payer: Ohio Health Group PPO SOMC Employees $56.78
Rate for Payer: PHCS Commercial $175.83
Rate for Payer: United Healthcare All Payer $161.18
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem Medicaid $4,431.12
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Humana KY Medicaid $4,431.12
Rate for Payer: Kentucky WC Medicaid $4,476.21
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Molina Healthcare Medicaid $4,520.02
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem Medicaid $4,431.12
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Humana KY Medicaid $4,431.12
Rate for Payer: Kentucky WC Medicaid $4,476.21
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Molina Healthcare Medicaid $4,520.02
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem Medicaid $4,431.12
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Humana KY Medicaid $4,431.12
Rate for Payer: Kentucky WC Medicaid $4,476.21
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Molina Healthcare Medicaid $4,520.02
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem Medicaid $4,431.12
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Humana KY Medicaid $4,431.12
Rate for Payer: Kentucky WC Medicaid $4,476.21
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Molina Healthcare Medicaid $4,520.02
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $1,675.04
Max. Negotiated Rate $12,369.50
Rate for Payer: Aetna Commercial $9,921.37
Rate for Payer: Anthem POS/PPO/Traditional $10,050.22
Rate for Payer: Cash Price $6,442.45
Rate for Payer: Cigna Commercial $10,694.47
Rate for Payer: First Health Commercial $12,240.66
Rate for Payer: Humana Commercial $10,952.16
Rate for Payer: Medical Mutual Of Ohio HMO $10,565.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $9,509.06
Rate for Payer: Molina Healthcare Benefit Exchange $3,865.47
Rate for Payer: Ohio Health Choice Commercial $11,338.71
Rate for Payer: Ohio Health Group HMO $9,663.68
Rate for Payer: Ohio Health Group PPO Differential $2,576.98
Rate for Payer: Ohio Health Group PPO No Differential $1,675.04
Rate for Payer: Ohio Health Group PPO SOMC Employees $3,994.32
Rate for Payer: PHCS Commercial $12,369.50
Rate for Payer: United Healthcare All Payer $11,338.71
Service Code HCPCS 23420
Hospital Charge Code 761P0459
Hospital Revenue Code 761
Min. Negotiated Rate $820.33
Max. Negotiated Rate $2,475.00
Rate for Payer: Aetna Commercial $1,445.33
Rate for Payer: Anthem Medicaid $820.33
Rate for Payer: Buckeye Medicare Advantage $2,475.00
Rate for Payer: Cash Price $1,237.50
Rate for Payer: Cash Price $1,237.50
Rate for Payer: Cigna Commercial $1,694.43
Rate for Payer: Healthspan PPO $1,309.16
Rate for Payer: Humana Medicaid $820.33
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,208.17
Rate for Payer: Molina Healthcare CHIP/Medicaid $836.74
Rate for Payer: Molina Healthcare Passport $820.33
Rate for Payer: Multiplan PHCS $1,485.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,732.50
Rate for Payer: UHCCP Medicaid $866.25
Rate for Payer: Wellcare CHIP/Medicaid $828.53
Service Code HCPCS 23420
Hospital Charge Code 76100459
Hospital Revenue Code 761
Min. Negotiated Rate $820.33
Max. Negotiated Rate $2,475.00
Rate for Payer: Aetna Commercial $1,445.33
Rate for Payer: Anthem Medicaid $820.33
Rate for Payer: Buckeye Medicare Advantage $2,475.00
Rate for Payer: Cash Price $1,237.50
Rate for Payer: Cash Price $1,237.50
Rate for Payer: Cigna Commercial $1,694.43
Rate for Payer: Healthspan PPO $1,309.16
Rate for Payer: Humana Medicaid $820.33
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,208.17
Rate for Payer: Molina Healthcare CHIP/Medicaid $836.74
Rate for Payer: Molina Healthcare Passport $820.33
Rate for Payer: Multiplan PHCS $1,485.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,732.50
Rate for Payer: UHCCP Medicaid $866.25
Rate for Payer: Wellcare CHIP/Medicaid $828.53