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Hospital Charge Code 22200325
Hospital Revenue Code 222
Min. Negotiated Rate $43.75
Max. Negotiated Rate $125.00
Rate for Payer: Buckeye Medicare Advantage $125.00
Rate for Payer: Cash Price $62.50
Rate for Payer: Multiplan PHCS $75.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $87.50
Rate for Payer: UHCCP Medicaid $43.75
Service Code HCPCS 15789
Hospital Charge Code 76100212
Hospital Revenue Code 761
Min. Negotiated Rate $248.56
Max. Negotiated Rate $1,835.52
Rate for Payer: Aetna Commercial $1,472.24
Rate for Payer: Anthem POS/PPO/Traditional $1,491.36
Rate for Payer: Cash Price $956.00
Rate for Payer: Cigna Commercial $1,586.96
Rate for Payer: First Health Commercial $1,816.40
Rate for Payer: Humana Commercial $1,625.20
Rate for Payer: Medical Mutual Of Ohio HMO $1,567.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,411.06
Rate for Payer: Molina Healthcare Benefit Exchange $573.60
Rate for Payer: Ohio Health Choice Commercial $1,682.56
Rate for Payer: Ohio Health Group HMO $1,434.00
Rate for Payer: Ohio Health Group PPO Differential $382.40
Rate for Payer: Ohio Health Group PPO No Differential $248.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $592.72
Rate for Payer: PHCS Commercial $1,835.52
Rate for Payer: United Healthcare All Payer $1,682.56
Service Code HCPCS 15789
Hospital Charge Code 76100212
Hospital Revenue Code 761
Min. Negotiated Rate $248.56
Max. Negotiated Rate $1,835.52
Rate for Payer: Aetna Commercial $1,472.24
Rate for Payer: Anthem Medicaid $657.54
Rate for Payer: Anthem Medicare Advantage/PPO $543.11
Rate for Payer: Anthem POS/PPO/Traditional $1,491.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $760.35
Rate for Payer: CareSource Just4Me Medicare $733.20
Rate for Payer: Cash Price $956.00
Rate for Payer: Cash Price $956.00
Rate for Payer: Cigna Commercial $1,586.96
Rate for Payer: First Health Commercial $1,816.40
Rate for Payer: Humana Commercial $1,625.20
Rate for Payer: Humana KY Medicaid $657.54
Rate for Payer: Humana Medicare Advantage $543.11
Rate for Payer: Kentucky WC Medicaid $664.23
Rate for Payer: Medical Mutual Of Ohio HMO $1,567.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,411.06
Rate for Payer: Molina Healthcare Benefit Exchange $651.73
Rate for Payer: Molina Healthcare Medicaid $670.73
Rate for Payer: Ohio Health Choice Commercial $1,682.56
Rate for Payer: Ohio Health Group HMO $1,434.00
Rate for Payer: Ohio Health Group PPO Differential $382.40
Rate for Payer: Ohio Health Group PPO No Differential $248.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $592.72
Rate for Payer: PHCS Commercial $1,835.52
Rate for Payer: United Healthcare All Payer $1,682.56
Service Code HCPCS 15789
Hospital Charge Code 76100212
Hospital Revenue Code 761
Min. Negotiated Rate $180.23
Max. Negotiated Rate $1,912.00
Rate for Payer: Aetna Commercial $590.48
Rate for Payer: Anthem Medicaid $180.23
Rate for Payer: Buckeye Medicare Advantage $1,912.00
Rate for Payer: Cash Price $956.00
Rate for Payer: Cash Price $956.00
Rate for Payer: Cigna Commercial $734.39
Rate for Payer: Healthspan PPO $615.08
Rate for Payer: Humana Medicaid $180.23
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $525.19
Rate for Payer: Molina Healthcare CHIP/Medicaid $183.83
Rate for Payer: Molina Healthcare Passport $180.23
Rate for Payer: Multiplan PHCS $1,147.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,338.40
Rate for Payer: UHCCP Medicaid $669.20
Rate for Payer: Wellcare CHIP/Medicaid $182.03
Service Code HCPCS 15789
Hospital Charge Code 761P0212
Hospital Revenue Code 761
Min. Negotiated Rate $180.23
Max. Negotiated Rate $1,200.00
Rate for Payer: Aetna Commercial $590.48
Rate for Payer: Anthem Medicaid $180.23
Rate for Payer: Buckeye Medicare Advantage $1,200.00
Rate for Payer: Cash Price $600.00
Rate for Payer: Cash Price $600.00
Rate for Payer: Cigna Commercial $734.39
Rate for Payer: Healthspan PPO $615.08
Rate for Payer: Humana Medicaid $180.23
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $525.19
Rate for Payer: Molina Healthcare CHIP/Medicaid $183.83
Rate for Payer: Molina Healthcare Passport $180.23
Rate for Payer: Multiplan PHCS $720.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $840.00
Rate for Payer: UHCCP Medicaid $420.00
Rate for Payer: Wellcare CHIP/Medicaid $182.03
Service Code HCPCS 15789
Hospital Charge Code 761T0212
Hospital Revenue Code 761
Min. Negotiated Rate $92.56
Max. Negotiated Rate $683.52
Rate for Payer: Aetna Commercial $548.24
Rate for Payer: Anthem POS/PPO/Traditional $555.36
Rate for Payer: Cash Price $356.00
Rate for Payer: Cigna Commercial $590.96
Rate for Payer: First Health Commercial $676.40
Rate for Payer: Humana Commercial $605.20
Rate for Payer: Medical Mutual Of Ohio HMO $583.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $525.46
Rate for Payer: Molina Healthcare Benefit Exchange $213.60
Rate for Payer: Ohio Health Choice Commercial $626.56
Rate for Payer: Ohio Health Group HMO $534.00
Rate for Payer: Ohio Health Group PPO Differential $142.40
Rate for Payer: Ohio Health Group PPO No Differential $92.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $220.72
Rate for Payer: PHCS Commercial $683.52
Rate for Payer: United Healthcare All Payer $626.56
Service Code HCPCS 15789
Hospital Charge Code 761T0212
Hospital Revenue Code 761
Min. Negotiated Rate $92.56
Max. Negotiated Rate $760.35
Rate for Payer: Aetna Commercial $548.24
Rate for Payer: Anthem Medicaid $244.86
Rate for Payer: Anthem Medicare Advantage/PPO $543.11
Rate for Payer: Anthem POS/PPO/Traditional $555.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $760.35
Rate for Payer: CareSource Just4Me Medicare $733.20
Rate for Payer: Cash Price $356.00
Rate for Payer: Cash Price $356.00
Rate for Payer: Cigna Commercial $590.96
Rate for Payer: First Health Commercial $676.40
Rate for Payer: Humana Commercial $605.20
Rate for Payer: Humana KY Medicaid $244.86
Rate for Payer: Humana Medicare Advantage $543.11
Rate for Payer: Kentucky WC Medicaid $247.35
Rate for Payer: Medical Mutual Of Ohio HMO $583.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $525.46
Rate for Payer: Molina Healthcare Benefit Exchange $651.73
Rate for Payer: Molina Healthcare Medicaid $249.77
Rate for Payer: Ohio Health Choice Commercial $626.56
Rate for Payer: Ohio Health Group HMO $534.00
Rate for Payer: Ohio Health Group PPO Differential $142.40
Rate for Payer: Ohio Health Group PPO No Differential $92.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $220.72
Rate for Payer: PHCS Commercial $683.52
Rate for Payer: United Healthcare All Payer $626.56
Service Code HCPCS 15788
Hospital Charge Code 76100211
Hospital Revenue Code 761
Min. Negotiated Rate $100.13
Max. Negotiated Rate $1,770.63
Rate for Payer: Aetna Commercial $324.37
Rate for Payer: Anthem Medicaid $100.13
Rate for Payer: Buckeye Medicare Advantage $1,770.63
Rate for Payer: Cash Price $885.32
Rate for Payer: Cash Price $885.32
Rate for Payer: Cigna Commercial $512.60
Rate for Payer: Healthspan PPO $454.52
Rate for Payer: Humana Medicaid $100.13
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $301.22
Rate for Payer: Molina Healthcare CHIP/Medicaid $102.13
Rate for Payer: Molina Healthcare Passport $100.13
Rate for Payer: Multiplan PHCS $1,062.38
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,239.44
Rate for Payer: UHCCP Medicaid $619.72
Rate for Payer: Wellcare CHIP/Medicaid $101.13
Service Code HCPCS 15788
Hospital Charge Code 76100211
Hospital Revenue Code 761
Min. Negotiated Rate $230.18
Max. Negotiated Rate $1,699.80
Rate for Payer: Aetna Commercial $1,363.39
Rate for Payer: Anthem POS/PPO/Traditional $1,381.09
Rate for Payer: Cash Price $885.32
Rate for Payer: Cigna Commercial $1,469.62
Rate for Payer: First Health Commercial $1,682.10
Rate for Payer: Humana Commercial $1,505.04
Rate for Payer: Medical Mutual Of Ohio HMO $1,451.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,306.72
Rate for Payer: Molina Healthcare Benefit Exchange $531.19
Rate for Payer: Ohio Health Choice Commercial $1,558.15
Rate for Payer: Ohio Health Group HMO $1,327.97
Rate for Payer: Ohio Health Group PPO Differential $354.13
Rate for Payer: Ohio Health Group PPO No Differential $230.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $548.90
Rate for Payer: PHCS Commercial $1,699.80
Rate for Payer: United Healthcare All Payer $1,558.15
Service Code HCPCS 15788
Hospital Charge Code 76100211
Hospital Revenue Code 761
Min. Negotiated Rate $230.18
Max. Negotiated Rate $1,699.80
Rate for Payer: Aetna Commercial $1,363.39
Rate for Payer: Anthem Medicaid $608.92
Rate for Payer: Anthem Medicare Advantage/PPO $344.82
Rate for Payer: Anthem POS/PPO/Traditional $1,381.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $482.75
Rate for Payer: CareSource Just4Me Medicare $465.51
Rate for Payer: Cash Price $885.32
Rate for Payer: Cash Price $885.32
Rate for Payer: Cigna Commercial $1,469.62
Rate for Payer: First Health Commercial $1,682.10
Rate for Payer: Humana Commercial $1,505.04
Rate for Payer: Humana KY Medicaid $608.92
Rate for Payer: Humana Medicare Advantage $344.82
Rate for Payer: Kentucky WC Medicaid $615.12
Rate for Payer: Medical Mutual Of Ohio HMO $1,451.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,306.72
Rate for Payer: Molina Healthcare Benefit Exchange $413.78
Rate for Payer: Molina Healthcare Medicaid $621.14
Rate for Payer: Ohio Health Choice Commercial $1,558.15
Rate for Payer: Ohio Health Group HMO $1,327.97
Rate for Payer: Ohio Health Group PPO Differential $354.13
Rate for Payer: Ohio Health Group PPO No Differential $230.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $548.90
Rate for Payer: PHCS Commercial $1,699.80
Rate for Payer: United Healthcare All Payer $1,558.15
Service Code HCPCS 15788
Hospital Charge Code 761T0211
Hospital Revenue Code 761
Min. Negotiated Rate $100.18
Max. Negotiated Rate $739.80
Rate for Payer: Aetna Commercial $593.39
Rate for Payer: Anthem POS/PPO/Traditional $601.09
Rate for Payer: Cash Price $385.32
Rate for Payer: Cigna Commercial $639.62
Rate for Payer: First Health Commercial $732.10
Rate for Payer: Humana Commercial $655.04
Rate for Payer: Medical Mutual Of Ohio HMO $631.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $568.72
Rate for Payer: Molina Healthcare Benefit Exchange $231.19
Rate for Payer: Ohio Health Choice Commercial $678.15
Rate for Payer: Ohio Health Group HMO $577.97
Rate for Payer: Ohio Health Group PPO Differential $154.13
Rate for Payer: Ohio Health Group PPO No Differential $100.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $238.90
Rate for Payer: PHCS Commercial $739.80
Rate for Payer: United Healthcare All Payer $678.15
Service Code HCPCS 15788
Hospital Charge Code 761P0211
Hospital Revenue Code 761
Min. Negotiated Rate $100.13
Max. Negotiated Rate $1,000.00
Rate for Payer: Aetna Commercial $324.37
Rate for Payer: Anthem Medicaid $100.13
Rate for Payer: Buckeye Medicare Advantage $1,000.00
Rate for Payer: Cash Price $500.00
Rate for Payer: Cash Price $500.00
Rate for Payer: Cigna Commercial $512.60
Rate for Payer: Healthspan PPO $454.52
Rate for Payer: Humana Medicaid $100.13
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $301.22
Rate for Payer: Molina Healthcare CHIP/Medicaid $102.13
Rate for Payer: Molina Healthcare Passport $100.13
Rate for Payer: Multiplan PHCS $600.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $700.00
Rate for Payer: UHCCP Medicaid $350.00
Rate for Payer: Wellcare CHIP/Medicaid $101.13
Service Code HCPCS 15788
Hospital Charge Code 761T0211
Hospital Revenue Code 761
Min. Negotiated Rate $100.18
Max. Negotiated Rate $739.80
Rate for Payer: Aetna Commercial $593.39
Rate for Payer: Anthem Medicaid $265.02
Rate for Payer: Anthem Medicare Advantage/PPO $344.82
Rate for Payer: Anthem POS/PPO/Traditional $601.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $482.75
Rate for Payer: CareSource Just4Me Medicare $465.51
Rate for Payer: Cash Price $385.32
Rate for Payer: Cash Price $385.32
Rate for Payer: Cigna Commercial $639.62
Rate for Payer: First Health Commercial $732.10
Rate for Payer: Humana Commercial $655.04
Rate for Payer: Humana KY Medicaid $265.02
Rate for Payer: Humana Medicare Advantage $344.82
Rate for Payer: Kentucky WC Medicaid $267.72
Rate for Payer: Medical Mutual Of Ohio HMO $631.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $568.72
Rate for Payer: Molina Healthcare Benefit Exchange $413.78
Rate for Payer: Molina Healthcare Medicaid $270.34
Rate for Payer: Ohio Health Choice Commercial $678.15
Rate for Payer: Ohio Health Group HMO $577.97
Rate for Payer: Ohio Health Group PPO Differential $154.13
Rate for Payer: Ohio Health Group PPO No Differential $100.18
Rate for Payer: Ohio Health Group PPO SOMC Employees $238.90
Rate for Payer: PHCS Commercial $739.80
Rate for Payer: United Healthcare All Payer $678.15
Service Code HCPCS 15793
Hospital Charge Code 761T2722
Hospital Revenue Code 761
Min. Negotiated Rate $101.40
Max. Negotiated Rate $748.80
Rate for Payer: Aetna Commercial $600.60
Rate for Payer: Anthem POS/PPO/Traditional $608.40
Rate for Payer: Cash Price $390.00
Rate for Payer: Cigna Commercial $647.40
Rate for Payer: First Health Commercial $741.00
Rate for Payer: Humana Commercial $663.00
Rate for Payer: Medical Mutual Of Ohio HMO $639.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $575.64
Rate for Payer: Molina Healthcare Benefit Exchange $234.00
Rate for Payer: Ohio Health Choice Commercial $686.40
Rate for Payer: Ohio Health Group HMO $585.00
Rate for Payer: Ohio Health Group PPO Differential $156.00
Rate for Payer: Ohio Health Group PPO No Differential $101.40
Rate for Payer: Ohio Health Group PPO SOMC Employees $241.80
Rate for Payer: PHCS Commercial $748.80
Rate for Payer: United Healthcare All Payer $686.40
Service Code HCPCS 15793
Hospital Charge Code 761T2722
Hospital Revenue Code 761
Min. Negotiated Rate $101.40
Max. Negotiated Rate $748.80
Rate for Payer: Aetna Commercial $600.60
Rate for Payer: Anthem Medicaid $268.24
Rate for Payer: Anthem Medicare Advantage/PPO $344.82
Rate for Payer: Anthem POS/PPO/Traditional $608.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $482.75
Rate for Payer: CareSource Just4Me Medicare $465.51
Rate for Payer: Cash Price $390.00
Rate for Payer: Cash Price $390.00
Rate for Payer: Cigna Commercial $647.40
Rate for Payer: First Health Commercial $741.00
Rate for Payer: Humana Commercial $663.00
Rate for Payer: Humana KY Medicaid $268.24
Rate for Payer: Humana Medicare Advantage $344.82
Rate for Payer: Kentucky WC Medicaid $270.97
Rate for Payer: Medical Mutual Of Ohio HMO $639.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $575.64
Rate for Payer: Molina Healthcare Benefit Exchange $413.78
Rate for Payer: Molina Healthcare Medicaid $273.62
Rate for Payer: Ohio Health Choice Commercial $686.40
Rate for Payer: Ohio Health Group HMO $585.00
Rate for Payer: Ohio Health Group PPO Differential $156.00
Rate for Payer: Ohio Health Group PPO No Differential $101.40
Rate for Payer: Ohio Health Group PPO SOMC Employees $241.80
Rate for Payer: PHCS Commercial $748.80
Rate for Payer: United Healthcare All Payer $686.40
Service Code HCPCS 15793
Hospital Charge Code 76102722
Hospital Revenue Code 761
Min. Negotiated Rate $187.20
Max. Negotiated Rate $1,382.40
Rate for Payer: Aetna Commercial $1,108.80
Rate for Payer: Anthem Medicaid $495.22
Rate for Payer: Anthem Medicare Advantage/PPO $344.82
Rate for Payer: Anthem POS/PPO/Traditional $1,123.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $482.75
Rate for Payer: CareSource Just4Me Medicare $465.51
Rate for Payer: Cash Price $720.00
Rate for Payer: Cash Price $720.00
Rate for Payer: Cigna Commercial $1,195.20
Rate for Payer: First Health Commercial $1,368.00
Rate for Payer: Humana Commercial $1,224.00
Rate for Payer: Humana KY Medicaid $495.22
Rate for Payer: Humana Medicare Advantage $344.82
Rate for Payer: Kentucky WC Medicaid $500.26
Rate for Payer: Medical Mutual Of Ohio HMO $1,180.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,062.72
Rate for Payer: Molina Healthcare Benefit Exchange $413.78
Rate for Payer: Molina Healthcare Medicaid $505.15
Rate for Payer: Ohio Health Choice Commercial $1,267.20
Rate for Payer: Ohio Health Group HMO $1,080.00
Rate for Payer: Ohio Health Group PPO Differential $288.00
Rate for Payer: Ohio Health Group PPO No Differential $187.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $446.40
Rate for Payer: PHCS Commercial $1,382.40
Rate for Payer: United Healthcare All Payer $1,267.20
Service Code HCPCS 15793
Hospital Charge Code 761P2722
Hospital Revenue Code 761
Min. Negotiated Rate $117.62
Max. Negotiated Rate $660.00
Rate for Payer: Aetna Commercial $489.90
Rate for Payer: Anthem Medicaid $117.62
Rate for Payer: Buckeye Medicare Advantage $660.00
Rate for Payer: Cash Price $330.00
Rate for Payer: Cash Price $330.00
Rate for Payer: Cigna Commercial $550.25
Rate for Payer: Healthspan PPO $511.54
Rate for Payer: Humana Medicaid $117.62
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $448.51
Rate for Payer: Molina Healthcare CHIP/Medicaid $119.97
Rate for Payer: Molina Healthcare Passport $117.62
Rate for Payer: Multiplan PHCS $396.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $462.00
Rate for Payer: UHCCP Medicaid $231.00
Rate for Payer: Wellcare CHIP/Medicaid $118.80
Service Code HCPCS 15793
Hospital Charge Code 76102722
Hospital Revenue Code 761
Min. Negotiated Rate $117.62
Max. Negotiated Rate $1,440.00
Rate for Payer: Aetna Commercial $489.90
Rate for Payer: Anthem Medicaid $117.62
Rate for Payer: Buckeye Medicare Advantage $1,440.00
Rate for Payer: Cash Price $720.00
Rate for Payer: Cash Price $720.00
Rate for Payer: Cigna Commercial $550.25
Rate for Payer: Healthspan PPO $511.54
Rate for Payer: Humana Medicaid $117.62
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $448.51
Rate for Payer: Molina Healthcare CHIP/Medicaid $119.97
Rate for Payer: Molina Healthcare Passport $117.62
Rate for Payer: Multiplan PHCS $864.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,008.00
Rate for Payer: UHCCP Medicaid $504.00
Rate for Payer: Wellcare CHIP/Medicaid $118.80
Service Code HCPCS 15793
Hospital Charge Code 76102722
Hospital Revenue Code 761
Min. Negotiated Rate $187.20
Max. Negotiated Rate $1,382.40
Rate for Payer: Aetna Commercial $1,108.80
Rate for Payer: Anthem POS/PPO/Traditional $1,123.20
Rate for Payer: Cash Price $720.00
Rate for Payer: Cigna Commercial $1,195.20
Rate for Payer: First Health Commercial $1,368.00
Rate for Payer: Humana Commercial $1,224.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,180.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,062.72
Rate for Payer: Molina Healthcare Benefit Exchange $432.00
Rate for Payer: Ohio Health Choice Commercial $1,267.20
Rate for Payer: Ohio Health Group HMO $1,080.00
Rate for Payer: Ohio Health Group PPO Differential $288.00
Rate for Payer: Ohio Health Group PPO No Differential $187.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $446.40
Rate for Payer: PHCS Commercial $1,382.40
Rate for Payer: United Healthcare All Payer $1,267.20
Service Code HCPCS 15792
Hospital Charge Code 761T2721
Hospital Revenue Code 761
Min. Negotiated Rate $87.10
Max. Negotiated Rate $760.35
Rate for Payer: Aetna Commercial $515.90
Rate for Payer: Anthem Medicaid $230.41
Rate for Payer: Anthem Medicare Advantage/PPO $543.11
Rate for Payer: Anthem POS/PPO/Traditional $522.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $760.35
Rate for Payer: CareSource Just4Me Medicare $733.20
Rate for Payer: Cash Price $335.00
Rate for Payer: Cash Price $335.00
Rate for Payer: Cigna Commercial $556.10
Rate for Payer: First Health Commercial $636.50
Rate for Payer: Humana Commercial $569.50
Rate for Payer: Humana KY Medicaid $230.41
Rate for Payer: Humana Medicare Advantage $543.11
Rate for Payer: Kentucky WC Medicaid $232.76
Rate for Payer: Medical Mutual Of Ohio HMO $549.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $494.46
Rate for Payer: Molina Healthcare Benefit Exchange $651.73
Rate for Payer: Molina Healthcare Medicaid $235.04
Rate for Payer: Ohio Health Choice Commercial $589.60
Rate for Payer: Ohio Health Group HMO $502.50
Rate for Payer: Ohio Health Group PPO Differential $134.00
Rate for Payer: Ohio Health Group PPO No Differential $87.10
Rate for Payer: Ohio Health Group PPO SOMC Employees $207.70
Rate for Payer: PHCS Commercial $643.20
Rate for Payer: United Healthcare All Payer $589.60
Service Code HCPCS 15792
Hospital Charge Code 76102721
Hospital Revenue Code 761
Min. Negotiated Rate $158.60
Max. Negotiated Rate $1,171.20
Rate for Payer: Aetna Commercial $939.40
Rate for Payer: Anthem Medicaid $419.56
Rate for Payer: Anthem Medicare Advantage/PPO $543.11
Rate for Payer: Anthem POS/PPO/Traditional $951.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $760.35
Rate for Payer: CareSource Just4Me Medicare $733.20
Rate for Payer: Cash Price $610.00
Rate for Payer: Cash Price $610.00
Rate for Payer: Cigna Commercial $1,012.60
Rate for Payer: First Health Commercial $1,159.00
Rate for Payer: Humana Commercial $1,037.00
Rate for Payer: Humana KY Medicaid $419.56
Rate for Payer: Humana Medicare Advantage $543.11
Rate for Payer: Kentucky WC Medicaid $423.83
Rate for Payer: Medical Mutual Of Ohio HMO $1,000.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $900.36
Rate for Payer: Molina Healthcare Benefit Exchange $651.73
Rate for Payer: Molina Healthcare Medicaid $427.98
Rate for Payer: Ohio Health Choice Commercial $1,073.60
Rate for Payer: Ohio Health Group HMO $915.00
Rate for Payer: Ohio Health Group PPO Differential $244.00
Rate for Payer: Ohio Health Group PPO No Differential $158.60
Rate for Payer: Ohio Health Group PPO SOMC Employees $378.20
Rate for Payer: PHCS Commercial $1,171.20
Rate for Payer: United Healthcare All Payer $1,073.60
Service Code HCPCS 15792
Hospital Charge Code 76102721
Hospital Revenue Code 761
Min. Negotiated Rate $65.39
Max. Negotiated Rate $1,220.00
Rate for Payer: Aetna Commercial $355.33
Rate for Payer: Anthem Medicaid $65.39
Rate for Payer: Buckeye Medicare Advantage $1,220.00
Rate for Payer: Cash Price $610.00
Rate for Payer: Cash Price $610.00
Rate for Payer: Cigna Commercial $493.61
Rate for Payer: Healthspan PPO $447.18
Rate for Payer: Humana Medicaid $65.39
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $320.23
Rate for Payer: Molina Healthcare CHIP/Medicaid $66.70
Rate for Payer: Molina Healthcare Passport $65.39
Rate for Payer: Multiplan PHCS $732.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $854.00
Rate for Payer: UHCCP Medicaid $427.00
Rate for Payer: Wellcare CHIP/Medicaid $66.04
Service Code HCPCS 15792
Hospital Charge Code 761P2721
Hospital Revenue Code 761
Min. Negotiated Rate $65.39
Max. Negotiated Rate $500.00
Rate for Payer: Aetna Commercial $355.33
Rate for Payer: Anthem Medicaid $65.39
Rate for Payer: Buckeye Medicare Advantage $500.00
Rate for Payer: Cash Price $250.00
Rate for Payer: Cash Price $250.00
Rate for Payer: Cigna Commercial $493.61
Rate for Payer: Healthspan PPO $447.18
Rate for Payer: Humana Medicaid $65.39
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $320.23
Rate for Payer: Molina Healthcare CHIP/Medicaid $66.70
Rate for Payer: Molina Healthcare Passport $65.39
Rate for Payer: Multiplan PHCS $300.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $350.00
Rate for Payer: UHCCP Medicaid $175.00
Rate for Payer: Wellcare CHIP/Medicaid $66.04
Service Code HCPCS 15792
Hospital Charge Code 761T2721
Hospital Revenue Code 761
Min. Negotiated Rate $87.10
Max. Negotiated Rate $643.20
Rate for Payer: Aetna Commercial $515.90
Rate for Payer: Anthem POS/PPO/Traditional $522.60
Rate for Payer: Cash Price $335.00
Rate for Payer: Cigna Commercial $556.10
Rate for Payer: First Health Commercial $636.50
Rate for Payer: Humana Commercial $569.50
Rate for Payer: Medical Mutual Of Ohio HMO $549.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $494.46
Rate for Payer: Molina Healthcare Benefit Exchange $201.00
Rate for Payer: Ohio Health Choice Commercial $589.60
Rate for Payer: Ohio Health Group HMO $502.50
Rate for Payer: Ohio Health Group PPO Differential $134.00
Rate for Payer: Ohio Health Group PPO No Differential $87.10
Rate for Payer: Ohio Health Group PPO SOMC Employees $207.70
Rate for Payer: PHCS Commercial $643.20
Rate for Payer: United Healthcare All Payer $589.60
Service Code HCPCS 15792
Hospital Charge Code 76102721
Hospital Revenue Code 761
Min. Negotiated Rate $158.60
Max. Negotiated Rate $1,171.20
Rate for Payer: Aetna Commercial $939.40
Rate for Payer: Anthem POS/PPO/Traditional $951.60
Rate for Payer: Cash Price $610.00
Rate for Payer: Cigna Commercial $1,012.60
Rate for Payer: First Health Commercial $1,159.00
Rate for Payer: Humana Commercial $1,037.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,000.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $900.36
Rate for Payer: Molina Healthcare Benefit Exchange $366.00
Rate for Payer: Ohio Health Choice Commercial $1,073.60
Rate for Payer: Ohio Health Group HMO $915.00
Rate for Payer: Ohio Health Group PPO Differential $244.00
Rate for Payer: Ohio Health Group PPO No Differential $158.60
Rate for Payer: Ohio Health Group PPO SOMC Employees $378.20
Rate for Payer: PHCS Commercial $1,171.20
Rate for Payer: United Healthcare All Payer $1,073.60