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Service Code NDC 68180042201
Hospital Charge Code 25003575
Hospital Revenue Code 250
Min. Negotiated Rate $0.20
Max. Negotiated Rate $1.44
Rate for Payer: Aetna Commercial $1.16
Rate for Payer: Anthem POS/PPO/Traditional $1.17
Rate for Payer: Cash Price $0.75
Rate for Payer: Cigna Commercial $1.24
Rate for Payer: First Health Commercial $1.42
Rate for Payer: Humana Commercial $1.28
Rate for Payer: Medical Mutual Of Ohio HMO $1.23
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1.11
Rate for Payer: Molina Healthcare Benefit Exchange $0.45
Rate for Payer: Ohio Health Choice Commercial $1.32
Rate for Payer: Ohio Health Group HMO $1.12
Rate for Payer: Ohio Health Group PPO Differential $0.30
Rate for Payer: Ohio Health Group PPO No Differential $0.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $0.47
Rate for Payer: PHCS Commercial $1.44
Rate for Payer: United Healthcare All Payer $1.32
Service Code NDC 131247835
Hospital Charge Code 25001670
Hospital Revenue Code 637
Min. Negotiated Rate $10.19
Max. Negotiated Rate $75.27
Rate for Payer: Aetna Commercial $60.38
Rate for Payer: Anthem POS/PPO/Traditional $61.16
Rate for Payer: Cash Price $39.20
Rate for Payer: Cigna Commercial $65.08
Rate for Payer: First Health Commercial $74.49
Rate for Payer: Humana Commercial $66.65
Rate for Payer: Medical Mutual Of Ohio HMO $64.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $57.87
Rate for Payer: Molina Healthcare Benefit Exchange $23.52
Rate for Payer: Ohio Health Choice Commercial $69.00
Rate for Payer: Ohio Health Group HMO $58.81
Rate for Payer: Ohio Health Group PPO Differential $15.68
Rate for Payer: Ohio Health Group PPO No Differential $10.19
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.31
Rate for Payer: PHCS Commercial $75.27
Rate for Payer: United Healthcare All Payer $69.00
Service Code NDC 131247835
Hospital Charge Code 25001670
Hospital Revenue Code 637
Min. Negotiated Rate $10.19
Max. Negotiated Rate $75.27
Rate for Payer: Aetna Commercial $60.38
Rate for Payer: Anthem Medicaid $26.97
Rate for Payer: Anthem POS/PPO/Traditional $61.16
Rate for Payer: Cash Price $39.20
Rate for Payer: Cigna Commercial $65.08
Rate for Payer: First Health Commercial $74.49
Rate for Payer: Humana Commercial $66.65
Rate for Payer: Humana KY Medicaid $26.97
Rate for Payer: Kentucky WC Medicaid $27.24
Rate for Payer: Medical Mutual Of Ohio HMO $64.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $57.87
Rate for Payer: Molina Healthcare Benefit Exchange $23.52
Rate for Payer: Molina Healthcare Medicaid $27.51
Rate for Payer: Ohio Health Choice Commercial $69.00
Rate for Payer: Ohio Health Group HMO $58.81
Rate for Payer: Ohio Health Group PPO Differential $15.68
Rate for Payer: Ohio Health Group PPO No Differential $10.19
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.31
Rate for Payer: PHCS Commercial $75.27
Rate for Payer: United Healthcare All Payer $69.00
Service Code NDC 131247935
Hospital Charge Code 25001671
Hospital Revenue Code 637
Min. Negotiated Rate $10.34
Max. Negotiated Rate $76.32
Rate for Payer: Aetna Commercial $61.22
Rate for Payer: Anthem POS/PPO/Traditional $62.01
Rate for Payer: Cash Price $39.75
Rate for Payer: Cigna Commercial $65.98
Rate for Payer: First Health Commercial $75.52
Rate for Payer: Humana Commercial $67.58
Rate for Payer: Medical Mutual Of Ohio HMO $65.19
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $58.67
Rate for Payer: Molina Healthcare Benefit Exchange $23.85
Rate for Payer: Ohio Health Choice Commercial $69.96
Rate for Payer: Ohio Health Group HMO $59.62
Rate for Payer: Ohio Health Group PPO Differential $15.90
Rate for Payer: Ohio Health Group PPO No Differential $10.34
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.64
Rate for Payer: PHCS Commercial $76.32
Rate for Payer: United Healthcare All Payer $69.96
Service Code NDC 131247935
Hospital Charge Code 25001671
Hospital Revenue Code 637
Min. Negotiated Rate $10.34
Max. Negotiated Rate $76.32
Rate for Payer: Aetna Commercial $61.22
Rate for Payer: Anthem Medicaid $27.34
Rate for Payer: Anthem POS/PPO/Traditional $62.01
Rate for Payer: Cash Price $39.75
Rate for Payer: Cigna Commercial $65.98
Rate for Payer: First Health Commercial $75.52
Rate for Payer: Humana Commercial $67.58
Rate for Payer: Humana KY Medicaid $27.34
Rate for Payer: Kentucky WC Medicaid $27.62
Rate for Payer: Medical Mutual Of Ohio HMO $65.19
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $58.67
Rate for Payer: Molina Healthcare Benefit Exchange $23.85
Rate for Payer: Molina Healthcare Medicaid $27.89
Rate for Payer: Ohio Health Choice Commercial $69.96
Rate for Payer: Ohio Health Group HMO $59.62
Rate for Payer: Ohio Health Group PPO Differential $15.90
Rate for Payer: Ohio Health Group PPO No Differential $10.34
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.64
Rate for Payer: PHCS Commercial $76.32
Rate for Payer: United Healthcare All Payer $69.96
Service Code HCPCS C9254
Hospital Charge Code 25001814
Hospital Revenue Code 636
Min. Negotiated Rate $21.78
Max. Negotiated Rate $160.80
Rate for Payer: Aetna Commercial $128.98
Rate for Payer: Anthem POS/PPO/Traditional $130.65
Rate for Payer: Cash Price $83.75
Rate for Payer: Cigna Commercial $139.02
Rate for Payer: First Health Commercial $159.12
Rate for Payer: Humana Commercial $142.38
Rate for Payer: Medical Mutual Of Ohio HMO $137.35
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $123.62
Rate for Payer: Molina Healthcare Benefit Exchange $50.25
Rate for Payer: Ohio Health Choice Commercial $147.40
Rate for Payer: Ohio Health Group HMO $125.62
Rate for Payer: Ohio Health Group PPO Differential $33.50
Rate for Payer: Ohio Health Group PPO No Differential $21.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $51.92
Rate for Payer: PHCS Commercial $160.80
Rate for Payer: United Healthcare All Payer $147.40
Service Code HCPCS C9254
Hospital Charge Code 25001814
Hospital Revenue Code 636
Min. Negotiated Rate $21.78
Max. Negotiated Rate $160.80
Rate for Payer: Aetna Commercial $128.98
Rate for Payer: Anthem Medicaid $57.60
Rate for Payer: Anthem POS/PPO/Traditional $130.65
Rate for Payer: Cash Price $83.75
Rate for Payer: Cigna Commercial $139.02
Rate for Payer: First Health Commercial $159.12
Rate for Payer: Humana Commercial $142.38
Rate for Payer: Humana KY Medicaid $57.60
Rate for Payer: Kentucky WC Medicaid $58.19
Rate for Payer: Medical Mutual Of Ohio HMO $137.35
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $123.62
Rate for Payer: Molina Healthcare Benefit Exchange $50.25
Rate for Payer: Molina Healthcare Medicaid $58.76
Rate for Payer: Ohio Health Choice Commercial $147.40
Rate for Payer: Ohio Health Group HMO $125.62
Rate for Payer: Ohio Health Group PPO Differential $33.50
Rate for Payer: Ohio Health Group PPO No Differential $21.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $51.92
Rate for Payer: PHCS Commercial $160.80
Rate for Payer: United Healthcare All Payer $147.40
Service Code NDC 131248035
Hospital Charge Code 25001672
Hospital Revenue Code 637
Min. Negotiated Rate $10.34
Max. Negotiated Rate $76.33
Rate for Payer: Aetna Commercial $61.22
Rate for Payer: Anthem POS/PPO/Traditional $62.02
Rate for Payer: Cash Price $39.76
Rate for Payer: Cigna Commercial $65.99
Rate for Payer: First Health Commercial $75.53
Rate for Payer: Humana Commercial $67.58
Rate for Payer: Medical Mutual Of Ohio HMO $65.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $58.68
Rate for Payer: Molina Healthcare Benefit Exchange $23.85
Rate for Payer: Ohio Health Choice Commercial $69.97
Rate for Payer: Ohio Health Group HMO $59.63
Rate for Payer: Ohio Health Group PPO Differential $15.90
Rate for Payer: Ohio Health Group PPO No Differential $10.34
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.65
Rate for Payer: PHCS Commercial $76.33
Rate for Payer: United Healthcare All Payer $69.97
Service Code NDC 131248035
Hospital Charge Code 25001672
Hospital Revenue Code 637
Min. Negotiated Rate $10.34
Max. Negotiated Rate $76.33
Rate for Payer: Aetna Commercial $61.22
Rate for Payer: Anthem Medicaid $27.34
Rate for Payer: Anthem POS/PPO/Traditional $62.02
Rate for Payer: Cash Price $39.76
Rate for Payer: Cigna Commercial $65.99
Rate for Payer: First Health Commercial $75.53
Rate for Payer: Humana Commercial $67.58
Rate for Payer: Humana KY Medicaid $27.34
Rate for Payer: Kentucky WC Medicaid $27.62
Rate for Payer: Medical Mutual Of Ohio HMO $65.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $58.68
Rate for Payer: Molina Healthcare Benefit Exchange $23.85
Rate for Payer: Molina Healthcare Medicaid $27.89
Rate for Payer: Ohio Health Choice Commercial $69.97
Rate for Payer: Ohio Health Group HMO $59.63
Rate for Payer: Ohio Health Group PPO Differential $15.90
Rate for Payer: Ohio Health Group PPO No Differential $10.34
Rate for Payer: Ohio Health Group PPO SOMC Employees $24.65
Rate for Payer: PHCS Commercial $76.33
Rate for Payer: United Healthcare All Payer $69.97
Service Code HCPCS J9360
Hospital Charge Code 25004298
Hospital Revenue Code 636
Min. Negotiated Rate $3.81
Max. Negotiated Rate $28.13
Rate for Payer: Aetna Commercial $22.56
Rate for Payer: Anthem Medicaid $10.08
Rate for Payer: Anthem POS/PPO/Traditional $22.85
Rate for Payer: Cash Price $14.65
Rate for Payer: Cigna Commercial $24.32
Rate for Payer: First Health Commercial $27.84
Rate for Payer: Humana Commercial $24.90
Rate for Payer: Humana KY Medicaid $10.08
Rate for Payer: Kentucky WC Medicaid $10.18
Rate for Payer: Medical Mutual Of Ohio HMO $24.03
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $21.62
Rate for Payer: Molina Healthcare Benefit Exchange $8.79
Rate for Payer: Molina Healthcare Medicaid $10.28
Rate for Payer: Ohio Health Choice Commercial $25.78
Rate for Payer: Ohio Health Group HMO $21.98
Rate for Payer: Ohio Health Group PPO Differential $5.86
Rate for Payer: Ohio Health Group PPO No Differential $3.81
Rate for Payer: Ohio Health Group PPO SOMC Employees $9.08
Rate for Payer: PHCS Commercial $28.13
Rate for Payer: United Healthcare All Payer $25.78
Service Code HCPCS J9360
Hospital Charge Code 25004298
Hospital Revenue Code 636
Min. Negotiated Rate $3.81
Max. Negotiated Rate $28.13
Rate for Payer: Aetna Commercial $22.56
Rate for Payer: Anthem POS/PPO/Traditional $22.85
Rate for Payer: Cash Price $14.65
Rate for Payer: Cigna Commercial $24.32
Rate for Payer: First Health Commercial $27.84
Rate for Payer: Humana Commercial $24.90
Rate for Payer: Medical Mutual Of Ohio HMO $24.03
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $21.62
Rate for Payer: Molina Healthcare Benefit Exchange $8.79
Rate for Payer: Ohio Health Choice Commercial $25.78
Rate for Payer: Ohio Health Group HMO $21.98
Rate for Payer: Ohio Health Group PPO Differential $5.86
Rate for Payer: Ohio Health Group PPO No Differential $3.81
Rate for Payer: Ohio Health Group PPO SOMC Employees $9.08
Rate for Payer: PHCS Commercial $28.13
Rate for Payer: United Healthcare All Payer $25.78
Service Code HCPCS J9370
Hospital Charge Code 25002690
Hospital Revenue Code 636
Min. Negotiated Rate $12.58
Max. Negotiated Rate $92.87
Rate for Payer: Aetna Commercial $74.49
Rate for Payer: Anthem Medicaid $33.27
Rate for Payer: Anthem POS/PPO/Traditional $75.46
Rate for Payer: Cash Price $48.37
Rate for Payer: Cigna Commercial $80.29
Rate for Payer: First Health Commercial $91.90
Rate for Payer: Humana Commercial $82.23
Rate for Payer: Humana KY Medicaid $33.27
Rate for Payer: Kentucky WC Medicaid $33.61
Rate for Payer: Medical Mutual Of Ohio HMO $79.33
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $71.39
Rate for Payer: Molina Healthcare Benefit Exchange $29.02
Rate for Payer: Molina Healthcare Medicaid $33.94
Rate for Payer: Ohio Health Choice Commercial $85.13
Rate for Payer: Ohio Health Group HMO $72.56
Rate for Payer: Ohio Health Group PPO Differential $19.35
Rate for Payer: Ohio Health Group PPO No Differential $12.58
Rate for Payer: Ohio Health Group PPO SOMC Employees $29.99
Rate for Payer: PHCS Commercial $92.87
Rate for Payer: United Healthcare All Payer $85.13
Service Code HCPCS J9370
Hospital Charge Code 25002690
Hospital Revenue Code 636
Min. Negotiated Rate $12.58
Max. Negotiated Rate $92.87
Rate for Payer: Aetna Commercial $74.49
Rate for Payer: Anthem POS/PPO/Traditional $75.46
Rate for Payer: Cash Price $48.37
Rate for Payer: Cigna Commercial $80.29
Rate for Payer: First Health Commercial $91.90
Rate for Payer: Humana Commercial $82.23
Rate for Payer: Medical Mutual Of Ohio HMO $79.33
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $71.39
Rate for Payer: Molina Healthcare Benefit Exchange $29.02
Rate for Payer: Ohio Health Choice Commercial $85.13
Rate for Payer: Ohio Health Group HMO $72.56
Rate for Payer: Ohio Health Group PPO Differential $19.35
Rate for Payer: Ohio Health Group PPO No Differential $12.58
Rate for Payer: Ohio Health Group PPO SOMC Employees $29.99
Rate for Payer: PHCS Commercial $92.87
Rate for Payer: United Healthcare All Payer $85.13
Service Code HCPCS J9370
Hospital Charge Code 25003916
Hospital Revenue Code 636
Min. Negotiated Rate $10.91
Max. Negotiated Rate $80.57
Rate for Payer: Aetna Commercial $64.63
Rate for Payer: Anthem POS/PPO/Traditional $65.47
Rate for Payer: Cash Price $41.97
Rate for Payer: Cigna Commercial $69.66
Rate for Payer: First Health Commercial $79.73
Rate for Payer: Humana Commercial $71.34
Rate for Payer: Medical Mutual Of Ohio HMO $68.82
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $61.94
Rate for Payer: Molina Healthcare Benefit Exchange $25.18
Rate for Payer: Ohio Health Choice Commercial $73.86
Rate for Payer: Ohio Health Group HMO $62.95
Rate for Payer: Ohio Health Group PPO Differential $16.79
Rate for Payer: Ohio Health Group PPO No Differential $10.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $26.02
Rate for Payer: PHCS Commercial $80.57
Rate for Payer: United Healthcare All Payer $73.86
Service Code HCPCS J9370
Hospital Charge Code 25003916
Hospital Revenue Code 636
Min. Negotiated Rate $10.91
Max. Negotiated Rate $80.57
Rate for Payer: Aetna Commercial $64.63
Rate for Payer: Anthem Medicaid $28.86
Rate for Payer: Anthem POS/PPO/Traditional $65.47
Rate for Payer: Cash Price $41.97
Rate for Payer: Cigna Commercial $69.66
Rate for Payer: First Health Commercial $79.73
Rate for Payer: Humana Commercial $71.34
Rate for Payer: Humana KY Medicaid $28.86
Rate for Payer: Kentucky WC Medicaid $29.16
Rate for Payer: Medical Mutual Of Ohio HMO $68.82
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $61.94
Rate for Payer: Molina Healthcare Benefit Exchange $25.18
Rate for Payer: Molina Healthcare Medicaid $29.44
Rate for Payer: Ohio Health Choice Commercial $73.86
Rate for Payer: Ohio Health Group HMO $62.95
Rate for Payer: Ohio Health Group PPO Differential $16.79
Rate for Payer: Ohio Health Group PPO No Differential $10.91
Rate for Payer: Ohio Health Group PPO SOMC Employees $26.02
Rate for Payer: PHCS Commercial $80.57
Rate for Payer: United Healthcare All Payer $73.86
Service Code HCPCS J9390
Hospital Charge Code 25002691
Hospital Revenue Code 636
Min. Negotiated Rate $17.71
Max. Negotiated Rate $130.80
Rate for Payer: Aetna Commercial $104.91
Rate for Payer: Anthem Medicaid $46.86
Rate for Payer: Anthem POS/PPO/Traditional $106.28
Rate for Payer: Cash Price $68.12
Rate for Payer: Cigna Commercial $113.09
Rate for Payer: First Health Commercial $129.44
Rate for Payer: Humana Commercial $115.81
Rate for Payer: Humana KY Medicaid $46.86
Rate for Payer: Kentucky WC Medicaid $47.33
Rate for Payer: Medical Mutual Of Ohio HMO $111.72
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $100.55
Rate for Payer: Molina Healthcare Benefit Exchange $40.88
Rate for Payer: Molina Healthcare Medicaid $47.80
Rate for Payer: Ohio Health Choice Commercial $119.90
Rate for Payer: Ohio Health Group HMO $102.19
Rate for Payer: Ohio Health Group PPO Differential $27.25
Rate for Payer: Ohio Health Group PPO No Differential $17.71
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.24
Rate for Payer: PHCS Commercial $130.80
Rate for Payer: United Healthcare All Payer $119.90
Service Code HCPCS J9390
Hospital Charge Code 25002691
Hospital Revenue Code 636
Min. Negotiated Rate $17.71
Max. Negotiated Rate $130.80
Rate for Payer: Aetna Commercial $104.91
Rate for Payer: Anthem POS/PPO/Traditional $106.28
Rate for Payer: Cash Price $68.12
Rate for Payer: Cigna Commercial $113.09
Rate for Payer: First Health Commercial $129.44
Rate for Payer: Humana Commercial $115.81
Rate for Payer: Medical Mutual Of Ohio HMO $111.72
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $100.55
Rate for Payer: Molina Healthcare Benefit Exchange $40.88
Rate for Payer: Ohio Health Choice Commercial $119.90
Rate for Payer: Ohio Health Group HMO $102.19
Rate for Payer: Ohio Health Group PPO Differential $27.25
Rate for Payer: Ohio Health Group PPO No Differential $17.71
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.24
Rate for Payer: PHCS Commercial $130.80
Rate for Payer: United Healthcare All Payer $119.90
Service Code HCPCS J9390
Hospital Charge Code 25003917
Hospital Revenue Code 636
Min. Negotiated Rate $63.76
Max. Negotiated Rate $470.88
Rate for Payer: Aetna Commercial $377.68
Rate for Payer: Anthem POS/PPO/Traditional $382.59
Rate for Payer: Cash Price $245.25
Rate for Payer: Cigna Commercial $407.12
Rate for Payer: First Health Commercial $465.98
Rate for Payer: Humana Commercial $416.92
Rate for Payer: Medical Mutual Of Ohio HMO $402.21
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $361.99
Rate for Payer: Molina Healthcare Benefit Exchange $147.15
Rate for Payer: Ohio Health Choice Commercial $431.64
Rate for Payer: Ohio Health Group HMO $367.88
Rate for Payer: Ohio Health Group PPO Differential $98.10
Rate for Payer: Ohio Health Group PPO No Differential $63.76
Rate for Payer: Ohio Health Group PPO SOMC Employees $152.06
Rate for Payer: PHCS Commercial $470.88
Rate for Payer: United Healthcare All Payer $431.64
Service Code HCPCS J9390
Hospital Charge Code 25003917
Hospital Revenue Code 636
Min. Negotiated Rate $63.76
Max. Negotiated Rate $470.88
Rate for Payer: Aetna Commercial $377.68
Rate for Payer: Anthem Medicaid $168.68
Rate for Payer: Anthem POS/PPO/Traditional $382.59
Rate for Payer: Cash Price $245.25
Rate for Payer: Cigna Commercial $407.12
Rate for Payer: First Health Commercial $465.98
Rate for Payer: Humana Commercial $416.92
Rate for Payer: Humana KY Medicaid $168.68
Rate for Payer: Kentucky WC Medicaid $170.40
Rate for Payer: Medical Mutual Of Ohio HMO $402.21
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $361.99
Rate for Payer: Molina Healthcare Benefit Exchange $147.15
Rate for Payer: Molina Healthcare Medicaid $172.07
Rate for Payer: Ohio Health Choice Commercial $431.64
Rate for Payer: Ohio Health Group HMO $367.88
Rate for Payer: Ohio Health Group PPO Differential $98.10
Rate for Payer: Ohio Health Group PPO No Differential $63.76
Rate for Payer: Ohio Health Group PPO SOMC Employees $152.06
Rate for Payer: PHCS Commercial $470.88
Rate for Payer: United Healthcare All Payer $431.64
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $271.05
Max. Negotiated Rate $2,001.60
Rate for Payer: Aetna Commercial $1,605.45
Rate for Payer: Anthem POS/PPO/Traditional $1,626.30
Rate for Payer: Cash Price $1,042.50
Rate for Payer: Cigna Commercial $1,730.55
Rate for Payer: First Health Commercial $1,980.75
Rate for Payer: Humana Commercial $1,772.25
Rate for Payer: Medical Mutual Of Ohio HMO $1,709.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,538.73
Rate for Payer: Molina Healthcare Benefit Exchange $625.50
Rate for Payer: Ohio Health Choice Commercial $1,834.80
Rate for Payer: Ohio Health Group HMO $1,563.75
Rate for Payer: Ohio Health Group PPO Differential $417.00
Rate for Payer: Ohio Health Group PPO No Differential $271.05
Rate for Payer: Ohio Health Group PPO SOMC Employees $646.35
Rate for Payer: PHCS Commercial $2,001.60
Rate for Payer: United Healthcare All Payer $1,834.80
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $271.05
Max. Negotiated Rate $2,001.60
Rate for Payer: Aetna Commercial $1,605.45
Rate for Payer: Anthem Medicaid $717.03
Rate for Payer: Anthem POS/PPO/Traditional $1,626.30
Rate for Payer: Cash Price $1,042.50
Rate for Payer: Cigna Commercial $1,730.55
Rate for Payer: First Health Commercial $1,980.75
Rate for Payer: Humana Commercial $1,772.25
Rate for Payer: Humana KY Medicaid $717.03
Rate for Payer: Kentucky WC Medicaid $724.33
Rate for Payer: Medical Mutual Of Ohio HMO $1,709.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,538.73
Rate for Payer: Molina Healthcare Benefit Exchange $625.50
Rate for Payer: Molina Healthcare Medicaid $731.42
Rate for Payer: Ohio Health Choice Commercial $1,834.80
Rate for Payer: Ohio Health Group HMO $1,563.75
Rate for Payer: Ohio Health Group PPO Differential $417.00
Rate for Payer: Ohio Health Group PPO No Differential $271.05
Rate for Payer: Ohio Health Group PPO SOMC Employees $646.35
Rate for Payer: PHCS Commercial $2,001.60
Rate for Payer: United Healthcare All Payer $1,834.80
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $252.85
Max. Negotiated Rate $1,867.20
Rate for Payer: Aetna Commercial $1,497.65
Rate for Payer: Anthem Medicaid $668.89
Rate for Payer: Anthem POS/PPO/Traditional $1,517.10
Rate for Payer: Cash Price $972.50
Rate for Payer: Cigna Commercial $1,614.35
Rate for Payer: First Health Commercial $1,847.75
Rate for Payer: Humana Commercial $1,653.25
Rate for Payer: Humana KY Medicaid $668.89
Rate for Payer: Kentucky WC Medicaid $675.69
Rate for Payer: Medical Mutual Of Ohio HMO $1,594.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,435.41
Rate for Payer: Molina Healthcare Benefit Exchange $583.50
Rate for Payer: Molina Healthcare Medicaid $682.31
Rate for Payer: Ohio Health Choice Commercial $1,711.60
Rate for Payer: Ohio Health Group HMO $1,458.75
Rate for Payer: Ohio Health Group PPO Differential $389.00
Rate for Payer: Ohio Health Group PPO No Differential $252.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $602.95
Rate for Payer: PHCS Commercial $1,867.20
Rate for Payer: United Healthcare All Payer $1,711.60
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $252.85
Max. Negotiated Rate $1,867.20
Rate for Payer: Aetna Commercial $1,497.65
Rate for Payer: Anthem POS/PPO/Traditional $1,517.10
Rate for Payer: Cash Price $972.50
Rate for Payer: Cigna Commercial $1,614.35
Rate for Payer: First Health Commercial $1,847.75
Rate for Payer: Humana Commercial $1,653.25
Rate for Payer: Medical Mutual Of Ohio HMO $1,594.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,435.41
Rate for Payer: Molina Healthcare Benefit Exchange $583.50
Rate for Payer: Ohio Health Choice Commercial $1,711.60
Rate for Payer: Ohio Health Group HMO $1,458.75
Rate for Payer: Ohio Health Group PPO Differential $389.00
Rate for Payer: Ohio Health Group PPO No Differential $252.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $602.95
Rate for Payer: PHCS Commercial $1,867.20
Rate for Payer: United Healthcare All Payer $1,711.60
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $266.50
Max. Negotiated Rate $1,968.00
Rate for Payer: Aetna Commercial $1,578.50
Rate for Payer: Anthem POS/PPO/Traditional $1,599.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cigna Commercial $1,701.50
Rate for Payer: First Health Commercial $1,947.50
Rate for Payer: Humana Commercial $1,742.50
Rate for Payer: Medical Mutual Of Ohio HMO $1,681.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,512.90
Rate for Payer: Molina Healthcare Benefit Exchange $615.00
Rate for Payer: Ohio Health Choice Commercial $1,804.00
Rate for Payer: Ohio Health Group HMO $1,537.50
Rate for Payer: Ohio Health Group PPO Differential $410.00
Rate for Payer: Ohio Health Group PPO No Differential $266.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $635.50
Rate for Payer: PHCS Commercial $1,968.00
Rate for Payer: United Healthcare All Payer $1,804.00
Service Code HCPCS C1769
Hospital Charge Code 27000056
Hospital Revenue Code 272
Min. Negotiated Rate $266.50
Max. Negotiated Rate $1,968.00
Rate for Payer: Aetna Commercial $1,578.50
Rate for Payer: Anthem Medicaid $705.00
Rate for Payer: Anthem POS/PPO/Traditional $1,599.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cigna Commercial $1,701.50
Rate for Payer: First Health Commercial $1,947.50
Rate for Payer: Humana Commercial $1,742.50
Rate for Payer: Humana KY Medicaid $705.00
Rate for Payer: Kentucky WC Medicaid $712.17
Rate for Payer: Medical Mutual Of Ohio HMO $1,681.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,512.90
Rate for Payer: Molina Healthcare Benefit Exchange $615.00
Rate for Payer: Molina Healthcare Medicaid $719.14
Rate for Payer: Ohio Health Choice Commercial $1,804.00
Rate for Payer: Ohio Health Group HMO $1,537.50
Rate for Payer: Ohio Health Group PPO Differential $410.00
Rate for Payer: Ohio Health Group PPO No Differential $266.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $635.50
Rate for Payer: PHCS Commercial $1,968.00
Rate for Payer: United Healthcare All Payer $1,804.00