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Service Code HCPCS 43870
Hospital Charge Code 76101800
Hospital Revenue Code 761
Min. Negotiated Rate $374.96
Max. Negotiated Rate $1,845.00
Rate for Payer: Aetna Commercial $1,009.54
Rate for Payer: Anthem Medicaid $374.96
Rate for Payer: Buckeye Medicare Advantage $1,845.00
Rate for Payer: Cash Price $922.50
Rate for Payer: Cash Price $922.50
Rate for Payer: Cigna Commercial $931.23
Rate for Payer: Healthspan PPO $851.36
Rate for Payer: Humana Medicaid $374.96
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $901.45
Rate for Payer: Molina Healthcare CHIP/Medicaid $382.46
Rate for Payer: Molina Healthcare Passport $374.96
Rate for Payer: Multiplan PHCS $1,107.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,291.50
Rate for Payer: UHCCP Medicaid $645.75
Rate for Payer: Wellcare CHIP/Medicaid $378.71
Service Code HCPCS 43870
Hospital Charge Code 76101800
Hospital Revenue Code 761
Min. Negotiated Rate $239.85
Max. Negotiated Rate $4,636.52
Rate for Payer: Aetna Commercial $1,420.65
Rate for Payer: Anthem Medicaid $634.50
Rate for Payer: Anthem Medicare Advantage/PPO $3,311.80
Rate for Payer: Anthem POS/PPO/Traditional $1,439.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $4,636.52
Rate for Payer: CareSource Just4Me Medicare $4,470.93
Rate for Payer: Cash Price $922.50
Rate for Payer: Cash Price $922.50
Rate for Payer: Cigna Commercial $1,531.35
Rate for Payer: First Health Commercial $1,752.75
Rate for Payer: Humana Commercial $1,568.25
Rate for Payer: Humana KY Medicaid $634.50
Rate for Payer: Humana Medicare Advantage $3,311.80
Rate for Payer: Kentucky WC Medicaid $640.95
Rate for Payer: Medical Mutual Of Ohio HMO $1,512.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,361.61
Rate for Payer: Molina Healthcare Benefit Exchange $3,974.16
Rate for Payer: Molina Healthcare Medicaid $647.23
Rate for Payer: Ohio Health Choice Commercial $1,623.60
Rate for Payer: Ohio Health Group HMO $1,383.75
Rate for Payer: Ohio Health Group PPO Differential $369.00
Rate for Payer: Ohio Health Group PPO No Differential $239.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $571.95
Rate for Payer: PHCS Commercial $1,771.20
Rate for Payer: United Healthcare All Payer $1,623.60
Service Code HCPCS 43870
Hospital Charge Code 76101800
Hospital Revenue Code 761
Min. Negotiated Rate $239.85
Max. Negotiated Rate $1,771.20
Rate for Payer: Aetna Commercial $1,420.65
Rate for Payer: Anthem POS/PPO/Traditional $1,439.10
Rate for Payer: Cash Price $922.50
Rate for Payer: Cigna Commercial $1,531.35
Rate for Payer: First Health Commercial $1,752.75
Rate for Payer: Humana Commercial $1,568.25
Rate for Payer: Medical Mutual Of Ohio HMO $1,512.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,361.61
Rate for Payer: Molina Healthcare Benefit Exchange $553.50
Rate for Payer: Ohio Health Choice Commercial $1,623.60
Rate for Payer: Ohio Health Group HMO $1,383.75
Rate for Payer: Ohio Health Group PPO Differential $369.00
Rate for Payer: Ohio Health Group PPO No Differential $239.85
Rate for Payer: Ohio Health Group PPO SOMC Employees $571.95
Rate for Payer: PHCS Commercial $1,771.20
Rate for Payer: United Healthcare All Payer $1,623.60
Service Code HCPCS 43870
Hospital Charge Code 761P1800
Hospital Revenue Code 761
Min. Negotiated Rate $374.96
Max. Negotiated Rate $1,845.00
Rate for Payer: Aetna Commercial $1,009.54
Rate for Payer: Anthem Medicaid $374.96
Rate for Payer: Buckeye Medicare Advantage $1,845.00
Rate for Payer: Cash Price $922.50
Rate for Payer: Cash Price $922.50
Rate for Payer: Cigna Commercial $931.23
Rate for Payer: Healthspan PPO $851.36
Rate for Payer: Humana Medicaid $374.96
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $901.45
Rate for Payer: Molina Healthcare CHIP/Medicaid $382.46
Rate for Payer: Molina Healthcare Passport $374.96
Rate for Payer: Multiplan PHCS $1,107.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,291.50
Rate for Payer: UHCCP Medicaid $645.75
Rate for Payer: Wellcare CHIP/Medicaid $378.71
Service Code HCPCS 57305
Hospital Charge Code 76102189
Hospital Revenue Code 761
Min. Negotiated Rate $495.41
Max. Negotiated Rate $2,200.00
Rate for Payer: Aetna Commercial $1,347.09
Rate for Payer: Anthem Medicaid $495.41
Rate for Payer: Buckeye Medicare Advantage $2,200.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cigna Commercial $1,284.23
Rate for Payer: Healthspan PPO $1,304.32
Rate for Payer: Humana Medicaid $495.41
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,188.67
Rate for Payer: Molina Healthcare CHIP/Medicaid $505.32
Rate for Payer: Molina Healthcare Passport $495.41
Rate for Payer: Multiplan PHCS $1,320.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,540.00
Rate for Payer: UHCCP Medicaid $770.00
Rate for Payer: Wellcare CHIP/Medicaid $500.36
Service Code HCPCS 57305
Hospital Charge Code 76102189
Hospital Revenue Code 761
Min. Negotiated Rate $286.00
Max. Negotiated Rate $2,112.00
Rate for Payer: Aetna Commercial $1,694.00
Rate for Payer: Anthem Medicaid $756.58
Rate for Payer: Anthem POS/PPO/Traditional $1,716.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cigna Commercial $1,826.00
Rate for Payer: First Health Commercial $2,090.00
Rate for Payer: Humana Commercial $1,870.00
Rate for Payer: Humana KY Medicaid $756.58
Rate for Payer: Kentucky WC Medicaid $764.28
Rate for Payer: Medical Mutual Of Ohio HMO $1,804.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,623.60
Rate for Payer: Molina Healthcare Benefit Exchange $660.00
Rate for Payer: Molina Healthcare Medicaid $771.76
Rate for Payer: Ohio Health Choice Commercial $1,936.00
Rate for Payer: Ohio Health Group HMO $1,650.00
Rate for Payer: Ohio Health Group PPO Differential $440.00
Rate for Payer: Ohio Health Group PPO No Differential $286.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $682.00
Rate for Payer: PHCS Commercial $2,112.00
Rate for Payer: United Healthcare All Payer $1,936.00
Service Code HCPCS 57305
Hospital Charge Code 76102189
Hospital Revenue Code 761
Min. Negotiated Rate $286.00
Max. Negotiated Rate $2,112.00
Rate for Payer: Aetna Commercial $1,694.00
Rate for Payer: Anthem POS/PPO/Traditional $1,716.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cigna Commercial $1,826.00
Rate for Payer: First Health Commercial $2,090.00
Rate for Payer: Humana Commercial $1,870.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,804.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,623.60
Rate for Payer: Molina Healthcare Benefit Exchange $660.00
Rate for Payer: Ohio Health Choice Commercial $1,936.00
Rate for Payer: Ohio Health Group HMO $1,650.00
Rate for Payer: Ohio Health Group PPO Differential $440.00
Rate for Payer: Ohio Health Group PPO No Differential $286.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $682.00
Rate for Payer: PHCS Commercial $2,112.00
Rate for Payer: United Healthcare All Payer $1,936.00
Service Code HCPCS 57305
Hospital Charge Code 761P2189
Hospital Revenue Code 761
Min. Negotiated Rate $495.41
Max. Negotiated Rate $2,200.00
Rate for Payer: Aetna Commercial $1,347.09
Rate for Payer: Anthem Medicaid $495.41
Rate for Payer: Buckeye Medicare Advantage $2,200.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cash Price $1,100.00
Rate for Payer: Cigna Commercial $1,284.23
Rate for Payer: Healthspan PPO $1,304.32
Rate for Payer: Humana Medicaid $495.41
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,188.67
Rate for Payer: Molina Healthcare CHIP/Medicaid $505.32
Rate for Payer: Molina Healthcare Passport $495.41
Rate for Payer: Multiplan PHCS $1,320.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,540.00
Rate for Payer: UHCCP Medicaid $770.00
Rate for Payer: Wellcare CHIP/Medicaid $500.36
Service Code HCPCS 51900
Hospital Charge Code 76102078
Hospital Revenue Code 761
Min. Negotiated Rate $689.18
Max. Negotiated Rate $3,800.00
Rate for Payer: Aetna Commercial $1,331.53
Rate for Payer: Anthem Medicaid $689.18
Rate for Payer: Buckeye Medicare Advantage $3,800.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cigna Commercial $1,199.56
Rate for Payer: Healthspan PPO $1,064.68
Rate for Payer: Humana Medicaid $689.18
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,114.48
Rate for Payer: Molina Healthcare CHIP/Medicaid $702.96
Rate for Payer: Molina Healthcare Passport $689.18
Rate for Payer: Multiplan PHCS $2,280.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,660.00
Rate for Payer: UHCCP Medicaid $1,330.00
Rate for Payer: Wellcare CHIP/Medicaid $696.07
Service Code HCPCS 51900
Hospital Charge Code 76102078
Hospital Revenue Code 761
Min. Negotiated Rate $494.00
Max. Negotiated Rate $3,648.00
Rate for Payer: Aetna Commercial $2,926.00
Rate for Payer: Anthem Medicaid $1,306.82
Rate for Payer: Anthem POS/PPO/Traditional $2,964.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cigna Commercial $3,154.00
Rate for Payer: First Health Commercial $3,610.00
Rate for Payer: Humana Commercial $3,230.00
Rate for Payer: Humana KY Medicaid $1,306.82
Rate for Payer: Kentucky WC Medicaid $1,320.12
Rate for Payer: Medical Mutual Of Ohio HMO $3,116.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,804.40
Rate for Payer: Molina Healthcare Benefit Exchange $1,140.00
Rate for Payer: Molina Healthcare Medicaid $1,333.04
Rate for Payer: Ohio Health Choice Commercial $3,344.00
Rate for Payer: Ohio Health Group HMO $2,850.00
Rate for Payer: Ohio Health Group PPO Differential $760.00
Rate for Payer: Ohio Health Group PPO No Differential $494.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,178.00
Rate for Payer: PHCS Commercial $3,648.00
Rate for Payer: United Healthcare All Payer $3,344.00
Service Code HCPCS 51900
Hospital Charge Code 76102078
Hospital Revenue Code 761
Min. Negotiated Rate $494.00
Max. Negotiated Rate $3,648.00
Rate for Payer: Aetna Commercial $2,926.00
Rate for Payer: Anthem POS/PPO/Traditional $2,964.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cigna Commercial $3,154.00
Rate for Payer: First Health Commercial $3,610.00
Rate for Payer: Humana Commercial $3,230.00
Rate for Payer: Medical Mutual Of Ohio HMO $3,116.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,804.40
Rate for Payer: Molina Healthcare Benefit Exchange $1,140.00
Rate for Payer: Ohio Health Choice Commercial $3,344.00
Rate for Payer: Ohio Health Group HMO $2,850.00
Rate for Payer: Ohio Health Group PPO Differential $760.00
Rate for Payer: Ohio Health Group PPO No Differential $494.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,178.00
Rate for Payer: PHCS Commercial $3,648.00
Rate for Payer: United Healthcare All Payer $3,344.00
Service Code HCPCS 51900
Hospital Charge Code 761P2078
Hospital Revenue Code 761
Min. Negotiated Rate $689.18
Max. Negotiated Rate $3,800.00
Rate for Payer: Aetna Commercial $1,331.53
Rate for Payer: Anthem Medicaid $689.18
Rate for Payer: Buckeye Medicare Advantage $3,800.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cash Price $1,900.00
Rate for Payer: Cigna Commercial $1,199.56
Rate for Payer: Healthspan PPO $1,064.68
Rate for Payer: Humana Medicaid $689.18
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,114.48
Rate for Payer: Molina Healthcare CHIP/Medicaid $702.96
Rate for Payer: Molina Healthcare Passport $689.18
Rate for Payer: Multiplan PHCS $2,280.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,660.00
Rate for Payer: UHCCP Medicaid $1,330.00
Rate for Payer: Wellcare CHIP/Medicaid $696.07
Hospital Charge Code 45000336
Hospital Revenue Code 450
Min. Negotiated Rate $30.55
Max. Negotiated Rate $225.60
Rate for Payer: Aetna Commercial $180.95
Rate for Payer: Anthem POS/PPO/Traditional $183.30
Rate for Payer: Cash Price $117.50
Rate for Payer: Cigna Commercial $195.05
Rate for Payer: First Health Commercial $223.25
Rate for Payer: Humana Commercial $199.75
Rate for Payer: Medical Mutual Of Ohio HMO $192.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $173.43
Rate for Payer: Molina Healthcare Benefit Exchange $70.50
Rate for Payer: Ohio Health Choice Commercial $206.80
Rate for Payer: Ohio Health Group HMO $176.25
Rate for Payer: Ohio Health Group PPO Differential $47.00
Rate for Payer: Ohio Health Group PPO No Differential $30.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $72.85
Rate for Payer: PHCS Commercial $225.60
Rate for Payer: United Healthcare All Payer $206.80
Hospital Charge Code 76102564
Hospital Revenue Code 761
Min. Negotiated Rate $29.25
Max. Negotiated Rate $216.00
Rate for Payer: Aetna Commercial $173.25
Rate for Payer: Anthem POS/PPO/Traditional $175.50
Rate for Payer: Cash Price $112.50
Rate for Payer: Cigna Commercial $186.75
Rate for Payer: First Health Commercial $213.75
Rate for Payer: Humana Commercial $191.25
Rate for Payer: Medical Mutual Of Ohio HMO $184.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $166.05
Rate for Payer: Molina Healthcare Benefit Exchange $67.50
Rate for Payer: Ohio Health Choice Commercial $198.00
Rate for Payer: Ohio Health Group HMO $168.75
Rate for Payer: Ohio Health Group PPO Differential $45.00
Rate for Payer: Ohio Health Group PPO No Differential $29.25
Rate for Payer: Ohio Health Group PPO SOMC Employees $69.75
Rate for Payer: PHCS Commercial $216.00
Rate for Payer: United Healthcare All Payer $198.00
Hospital Charge Code 45000336
Hospital Revenue Code 450
Min. Negotiated Rate $30.55
Max. Negotiated Rate $225.60
Rate for Payer: Aetna Commercial $180.95
Rate for Payer: Anthem Medicaid $80.82
Rate for Payer: Anthem POS/PPO/Traditional $183.30
Rate for Payer: Cash Price $117.50
Rate for Payer: Cigna Commercial $195.05
Rate for Payer: First Health Commercial $223.25
Rate for Payer: Humana Commercial $199.75
Rate for Payer: Humana KY Medicaid $80.82
Rate for Payer: Kentucky WC Medicaid $81.64
Rate for Payer: Medical Mutual Of Ohio HMO $192.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $173.43
Rate for Payer: Molina Healthcare Benefit Exchange $70.50
Rate for Payer: Molina Healthcare Medicaid $82.44
Rate for Payer: Ohio Health Choice Commercial $206.80
Rate for Payer: Ohio Health Group HMO $176.25
Rate for Payer: Ohio Health Group PPO Differential $47.00
Rate for Payer: Ohio Health Group PPO No Differential $30.55
Rate for Payer: Ohio Health Group PPO SOMC Employees $72.85
Rate for Payer: PHCS Commercial $225.60
Rate for Payer: United Healthcare All Payer $206.80
Hospital Charge Code 76102564
Hospital Revenue Code 761
Min. Negotiated Rate $29.25
Max. Negotiated Rate $216.00
Rate for Payer: Aetna Commercial $173.25
Rate for Payer: Anthem Medicaid $77.38
Rate for Payer: Anthem POS/PPO/Traditional $175.50
Rate for Payer: Cash Price $112.50
Rate for Payer: Cigna Commercial $186.75
Rate for Payer: First Health Commercial $213.75
Rate for Payer: Humana Commercial $191.25
Rate for Payer: Humana KY Medicaid $77.38
Rate for Payer: Kentucky WC Medicaid $78.16
Rate for Payer: Medical Mutual Of Ohio HMO $184.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $166.05
Rate for Payer: Molina Healthcare Benefit Exchange $67.50
Rate for Payer: Molina Healthcare Medicaid $78.93
Rate for Payer: Ohio Health Choice Commercial $198.00
Rate for Payer: Ohio Health Group HMO $168.75
Rate for Payer: Ohio Health Group PPO Differential $45.00
Rate for Payer: Ohio Health Group PPO No Differential $29.25
Rate for Payer: Ohio Health Group PPO SOMC Employees $69.75
Rate for Payer: PHCS Commercial $216.00
Rate for Payer: United Healthcare All Payer $198.00
Service Code HCPCS 44620
Hospital Charge Code 76101859
Hospital Revenue Code 761
Min. Negotiated Rate $169.00
Max. Negotiated Rate $1,248.00
Rate for Payer: Aetna Commercial $1,001.00
Rate for Payer: Anthem Medicaid $447.07
Rate for Payer: Anthem POS/PPO/Traditional $1,014.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cigna Commercial $1,079.00
Rate for Payer: First Health Commercial $1,235.00
Rate for Payer: Humana Commercial $1,105.00
Rate for Payer: Humana KY Medicaid $447.07
Rate for Payer: Kentucky WC Medicaid $451.62
Rate for Payer: Medical Mutual Of Ohio HMO $1,066.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $959.40
Rate for Payer: Molina Healthcare Benefit Exchange $390.00
Rate for Payer: Molina Healthcare Medicaid $456.04
Rate for Payer: Ohio Health Choice Commercial $1,144.00
Rate for Payer: Ohio Health Group HMO $975.00
Rate for Payer: Ohio Health Group PPO Differential $260.00
Rate for Payer: Ohio Health Group PPO No Differential $169.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $403.00
Rate for Payer: PHCS Commercial $1,248.00
Rate for Payer: United Healthcare All Payer $1,144.00
Service Code HCPCS 44620
Hospital Charge Code 76101859
Hospital Revenue Code 761
Min. Negotiated Rate $455.00
Max. Negotiated Rate $1,300.00
Rate for Payer: Aetna Commercial $1,237.24
Rate for Payer: Anthem Medicaid $473.91
Rate for Payer: Buckeye Medicare Advantage $1,300.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cigna Commercial $1,144.44
Rate for Payer: Healthspan PPO $1,043.39
Rate for Payer: Humana Medicaid $473.91
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,101.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $483.39
Rate for Payer: Molina Healthcare Passport $473.91
Rate for Payer: Multiplan PHCS $780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $910.00
Rate for Payer: UHCCP Medicaid $455.00
Rate for Payer: Wellcare CHIP/Medicaid $478.65
Service Code HCPCS 44620
Hospital Charge Code 76101859
Hospital Revenue Code 761
Min. Negotiated Rate $169.00
Max. Negotiated Rate $1,248.00
Rate for Payer: Aetna Commercial $1,001.00
Rate for Payer: Anthem POS/PPO/Traditional $1,014.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cigna Commercial $1,079.00
Rate for Payer: First Health Commercial $1,235.00
Rate for Payer: Humana Commercial $1,105.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,066.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $959.40
Rate for Payer: Molina Healthcare Benefit Exchange $390.00
Rate for Payer: Ohio Health Choice Commercial $1,144.00
Rate for Payer: Ohio Health Group HMO $975.00
Rate for Payer: Ohio Health Group PPO Differential $260.00
Rate for Payer: Ohio Health Group PPO No Differential $169.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $403.00
Rate for Payer: PHCS Commercial $1,248.00
Rate for Payer: United Healthcare All Payer $1,144.00
Service Code HCPCS 44620
Hospital Charge Code 761P1859
Hospital Revenue Code 761
Min. Negotiated Rate $455.00
Max. Negotiated Rate $1,300.00
Rate for Payer: Aetna Commercial $1,237.24
Rate for Payer: Anthem Medicaid $473.91
Rate for Payer: Buckeye Medicare Advantage $1,300.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cash Price $650.00
Rate for Payer: Cigna Commercial $1,144.44
Rate for Payer: Healthspan PPO $1,043.39
Rate for Payer: Humana Medicaid $473.91
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,101.71
Rate for Payer: Molina Healthcare CHIP/Medicaid $483.39
Rate for Payer: Molina Healthcare Passport $473.91
Rate for Payer: Multiplan PHCS $780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $910.00
Rate for Payer: UHCCP Medicaid $455.00
Rate for Payer: Wellcare CHIP/Medicaid $478.65
Service Code HCPCS 44625
Hospital Charge Code 76101860
Hospital Revenue Code 761
Min. Negotiated Rate $661.34
Max. Negotiated Rate $2,050.00
Rate for Payer: Aetna Commercial $1,468.43
Rate for Payer: Anthem Medicaid $661.34
Rate for Payer: Buckeye Medicare Advantage $2,050.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cigna Commercial $1,365.06
Rate for Payer: Healthspan PPO $1,238.36
Rate for Payer: Humana Medicaid $661.34
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,299.41
Rate for Payer: Molina Healthcare CHIP/Medicaid $674.57
Rate for Payer: Molina Healthcare Passport $661.34
Rate for Payer: Multiplan PHCS $1,230.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,435.00
Rate for Payer: UHCCP Medicaid $717.50
Rate for Payer: Wellcare CHIP/Medicaid $667.95
Service Code HCPCS 44625
Hospital Charge Code 76101860
Hospital Revenue Code 761
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
Service Code HCPCS 44625
Hospital Charge Code 76101860
Hospital Revenue Code 761
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 44625
Hospital Charge Code 761P1860
Hospital Revenue Code 761
Min. Negotiated Rate $661.34
Max. Negotiated Rate $2,050.00
Rate for Payer: Aetna Commercial $1,468.43
Rate for Payer: Anthem Medicaid $661.34
Rate for Payer: Buckeye Medicare Advantage $2,050.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cash Price $1,025.00
Rate for Payer: Cigna Commercial $1,365.06
Rate for Payer: Healthspan PPO $1,238.36
Rate for Payer: Humana Medicaid $661.34
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,299.41
Rate for Payer: Molina Healthcare CHIP/Medicaid $674.57
Rate for Payer: Molina Healthcare Passport $661.34
Rate for Payer: Multiplan PHCS $1,230.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,435.00
Rate for Payer: UHCCP Medicaid $717.50
Rate for Payer: Wellcare CHIP/Medicaid $667.95
Service Code HCPCS 67875
Hospital Charge Code 76102392
Hospital Revenue Code 761
Min. Negotiated Rate $47.59
Max. Negotiated Rate $3,892.28
Rate for Payer: Aetna Commercial $130.56
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $47.59
Rate for Payer: Anthem Medicaid $88.91
Rate for Payer: Buckeye Medicare Advantage $3,892.28
Rate for Payer: Cash Price $1,946.14
Rate for Payer: Cash Price $1,946.14
Rate for Payer: Cigna Commercial $126.14
Rate for Payer: Healthspan PPO $198.42
Rate for Payer: Humana Medicaid $88.91
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $123.02
Rate for Payer: Molina Healthcare CHIP/Medicaid $90.69
Rate for Payer: Molina Healthcare Passport $88.91
Rate for Payer: Multiplan PHCS $2,335.37
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,724.60
Rate for Payer: UHCCP Medicaid $49.97
Rate for Payer: Wellcare CHIP/Medicaid $89.80