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Service Code HCPCS 26740
Hospital Charge Code 761T0740
Hospital Revenue Code 761
Min. Negotiated Rate $221.64
Max. Negotiated Rate $696.00
Rate for Payer: Aetna Commercial $558.25
Rate for Payer: Anthem Medicaid $249.33
Rate for Payer: Anthem Medicare Advantage/PPO $221.64
Rate for Payer: Anthem POS/PPO/Traditional $565.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $310.30
Rate for Payer: CareSource Just4Me Medicare $299.21
Rate for Payer: Cash Price $362.50
Rate for Payer: Cash Price $362.50
Rate for Payer: Cigna Commercial $601.75
Rate for Payer: First Health Commercial $688.75
Rate for Payer: Humana Commercial $616.25
Rate for Payer: Humana KY Medicaid $249.33
Rate for Payer: Humana Medicare Advantage $221.64
Rate for Payer: Kentucky WC Medicaid $251.87
Rate for Payer: Medical Mutual Of Ohio HMO $594.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $535.05
Rate for Payer: Molina Healthcare Benefit Exchange $265.97
Rate for Payer: Molina Healthcare Medicaid $254.33
Rate for Payer: Ohio Health Choice Commercial $638.00
Rate for Payer: Ohio Health Group HMO $543.75
Rate for Payer: Ohio Health Group PPO Differential $580.00
Rate for Payer: Ohio Health Group PPO No Differential $630.75
Rate for Payer: Ohio Health Group PPO SOMC Employees $500.25
Rate for Payer: PHCS Commercial $696.00
Rate for Payer: United Healthcare All Payer $638.00
Service Code HCPCS 26742
Hospital Charge Code 761P0741
Hospital Revenue Code 761
Min. Negotiated Rate $169.45
Max. Negotiated Rate $572.51
Rate for Payer: Aetna Commercial $463.39
Rate for Payer: Ambetter Exchange $325.37
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $180.60
Rate for Payer: Anthem Medicaid $169.45
Rate for Payer: Buckeye Individual/Medicaid $325.37
Rate for Payer: Buckeye Medicare Advantage $325.37
Rate for Payer: CareSource Just4Me Medicare $390.44
Rate for Payer: Cash Price $375.00
Rate for Payer: Cash Price $375.00
Rate for Payer: Cigna Commercial $572.51
Rate for Payer: Healthspan PPO $458.03
Rate for Payer: Humana Medicaid $169.45
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $400.27
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $325.37
Rate for Payer: Molina Healthcare Benefit Exchange $325.37
Rate for Payer: Molina Healthcare CHIP/Medicaid $172.84
Rate for Payer: Molina Healthcare Passport $169.45
Rate for Payer: Multiplan PHCS $450.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $422.98
Rate for Payer: UHCCP Medicaid $189.63
Rate for Payer: Wellcare CHIP/Medicaid $171.14
Rate for Payer: Wellcare Medicare Advantage $325.37
Service Code HCPCS 26742
Hospital Charge Code 45000145
Hospital Revenue Code 450
Min. Negotiated Rate $633.30
Max. Negotiated Rate $2,026.56
Rate for Payer: Aetna Commercial $1,625.47
Rate for Payer: Anthem POS/PPO/Traditional $1,646.58
Rate for Payer: Cash Price $1,055.50
Rate for Payer: Cigna Commercial $1,752.13
Rate for Payer: First Health Commercial $2,005.45
Rate for Payer: Humana Commercial $1,794.35
Rate for Payer: Medical Mutual Of Ohio HMO $1,731.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,557.92
Rate for Payer: Molina Healthcare Benefit Exchange $633.30
Rate for Payer: Ohio Health Choice Commercial $1,857.68
Rate for Payer: Ohio Health Group HMO $1,583.25
Rate for Payer: Ohio Health Group PPO Differential $1,688.80
Rate for Payer: Ohio Health Group PPO No Differential $1,836.57
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,456.59
Rate for Payer: PHCS Commercial $2,026.56
Rate for Payer: United Healthcare All Payer $1,857.68
Service Code HCPCS 26742
Hospital Charge Code 45000145
Hospital Revenue Code 450
Min. Negotiated Rate $725.97
Max. Negotiated Rate $2,070.25
Rate for Payer: Aetna Commercial $1,625.47
Rate for Payer: Anthem Medicaid $725.97
Rate for Payer: Anthem Medicare Advantage/PPO $1,478.75
Rate for Payer: Anthem POS/PPO/Traditional $1,646.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,070.25
Rate for Payer: CareSource Just4Me Medicare $1,996.31
Rate for Payer: Cash Price $1,055.50
Rate for Payer: Cash Price $1,055.50
Rate for Payer: Cigna Commercial $1,752.13
Rate for Payer: First Health Commercial $2,005.45
Rate for Payer: Humana Commercial $1,794.35
Rate for Payer: Humana KY Medicaid $725.97
Rate for Payer: Humana Medicare Advantage $1,478.75
Rate for Payer: Kentucky WC Medicaid $733.36
Rate for Payer: Medical Mutual Of Ohio HMO $1,731.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,557.92
Rate for Payer: Molina Healthcare Benefit Exchange $1,774.50
Rate for Payer: Molina Healthcare Medicaid $740.54
Rate for Payer: Ohio Health Choice Commercial $1,857.68
Rate for Payer: Ohio Health Group HMO $1,583.25
Rate for Payer: Ohio Health Group PPO Differential $1,688.80
Rate for Payer: Ohio Health Group PPO No Differential $1,836.57
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,456.59
Rate for Payer: PHCS Commercial $2,026.56
Rate for Payer: United Healthcare All Payer $1,857.68
Service Code HCPCS 26742
Hospital Charge Code 76100741
Hospital Revenue Code 761
Min. Negotiated Rate $225.00
Max. Negotiated Rate $720.00
Rate for Payer: Aetna Commercial $577.50
Rate for Payer: Anthem POS/PPO/Traditional $585.00
Rate for Payer: Cash Price $375.00
Rate for Payer: Cigna Commercial $622.50
Rate for Payer: First Health Commercial $712.50
Rate for Payer: Humana Commercial $637.50
Rate for Payer: Medical Mutual Of Ohio HMO $615.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $553.50
Rate for Payer: Molina Healthcare Benefit Exchange $225.00
Rate for Payer: Ohio Health Choice Commercial $660.00
Rate for Payer: Ohio Health Group HMO $562.50
Rate for Payer: Ohio Health Group PPO Differential $600.00
Rate for Payer: Ohio Health Group PPO No Differential $652.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $517.50
Rate for Payer: PHCS Commercial $720.00
Rate for Payer: United Healthcare All Payer $660.00
Service Code HCPCS 26742
Hospital Charge Code 76100741
Hospital Revenue Code 761
Min. Negotiated Rate $169.45
Max. Negotiated Rate $572.51
Rate for Payer: Aetna Commercial $463.39
Rate for Payer: Ambetter Exchange $325.37
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $180.60
Rate for Payer: Anthem Medicaid $169.45
Rate for Payer: Buckeye Individual/Medicaid $325.37
Rate for Payer: Buckeye Medicare Advantage $325.37
Rate for Payer: CareSource Just4Me Medicare $390.44
Rate for Payer: Cash Price $375.00
Rate for Payer: Cash Price $375.00
Rate for Payer: Cigna Commercial $572.51
Rate for Payer: Healthspan PPO $458.03
Rate for Payer: Humana Medicaid $169.45
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $400.27
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $325.37
Rate for Payer: Molina Healthcare Benefit Exchange $325.37
Rate for Payer: Molina Healthcare CHIP/Medicaid $172.84
Rate for Payer: Molina Healthcare Passport $169.45
Rate for Payer: Multiplan PHCS $450.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $422.98
Rate for Payer: UHCCP Medicaid $189.63
Rate for Payer: Wellcare CHIP/Medicaid $171.14
Rate for Payer: Wellcare Medicare Advantage $325.37
Service Code HCPCS 26742
Hospital Charge Code 76100741
Hospital Revenue Code 761
Min. Negotiated Rate $257.93
Max. Negotiated Rate $2,070.25
Rate for Payer: Aetna Commercial $577.50
Rate for Payer: Anthem Medicaid $257.93
Rate for Payer: Anthem Medicare Advantage/PPO $1,478.75
Rate for Payer: Anthem POS/PPO/Traditional $585.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,070.25
Rate for Payer: CareSource Just4Me Medicare $1,996.31
Rate for Payer: Cash Price $375.00
Rate for Payer: Cash Price $375.00
Rate for Payer: Cigna Commercial $622.50
Rate for Payer: First Health Commercial $712.50
Rate for Payer: Humana Commercial $637.50
Rate for Payer: Humana KY Medicaid $257.93
Rate for Payer: Humana Medicare Advantage $1,478.75
Rate for Payer: Kentucky WC Medicaid $260.55
Rate for Payer: Medical Mutual Of Ohio HMO $615.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $553.50
Rate for Payer: Molina Healthcare Benefit Exchange $1,774.50
Rate for Payer: Molina Healthcare Medicaid $263.10
Rate for Payer: Ohio Health Choice Commercial $660.00
Rate for Payer: Ohio Health Group HMO $562.50
Rate for Payer: Ohio Health Group PPO Differential $600.00
Rate for Payer: Ohio Health Group PPO No Differential $652.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $517.50
Rate for Payer: PHCS Commercial $720.00
Rate for Payer: United Healthcare All Payer $660.00
Service Code HCPCS 25635
Hospital Charge Code 76100640
Hospital Revenue Code 761
Min. Negotiated Rate $220.10
Max. Negotiated Rate $569.41
Rate for Payer: Aetna Commercial $540.85
Rate for Payer: Ambetter Exchange $409.49
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $220.10
Rate for Payer: Anthem Medicaid $224.34
Rate for Payer: Buckeye Individual/Medicaid $409.49
Rate for Payer: Buckeye Medicare Advantage $409.49
Rate for Payer: CareSource Just4Me Medicare $491.39
Rate for Payer: Cash Price $419.00
Rate for Payer: Cash Price $419.00
Rate for Payer: Cigna Commercial $569.41
Rate for Payer: Healthspan PPO $543.23
Rate for Payer: Humana Medicaid $224.34
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $485.23
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $409.49
Rate for Payer: Molina Healthcare Benefit Exchange $409.49
Rate for Payer: Molina Healthcare CHIP/Medicaid $228.83
Rate for Payer: Molina Healthcare Passport $224.34
Rate for Payer: Multiplan PHCS $502.80
Rate for Payer: Ohio Health Choice Preferred Health Choice $532.34
Rate for Payer: UHCCP Medicaid $231.10
Rate for Payer: Wellcare CHIP/Medicaid $226.58
Rate for Payer: Wellcare Medicare Advantage $409.49
Service Code HCPCS 25635
Hospital Charge Code 76100640
Hospital Revenue Code 761
Min. Negotiated Rate $251.40
Max. Negotiated Rate $804.48
Rate for Payer: Aetna Commercial $645.26
Rate for Payer: Anthem POS/PPO/Traditional $653.64
Rate for Payer: Cash Price $419.00
Rate for Payer: Cigna Commercial $695.54
Rate for Payer: First Health Commercial $796.10
Rate for Payer: Humana Commercial $712.30
Rate for Payer: Medical Mutual Of Ohio HMO $687.16
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $618.44
Rate for Payer: Molina Healthcare Benefit Exchange $251.40
Rate for Payer: Ohio Health Choice Commercial $737.44
Rate for Payer: Ohio Health Group HMO $628.50
Rate for Payer: Ohio Health Group PPO Differential $670.40
Rate for Payer: Ohio Health Group PPO No Differential $729.06
Rate for Payer: Ohio Health Group PPO SOMC Employees $578.22
Rate for Payer: PHCS Commercial $804.48
Rate for Payer: United Healthcare All Payer $737.44
Service Code HCPCS 25635
Hospital Charge Code 76100640
Hospital Revenue Code 761
Min. Negotiated Rate $288.19
Max. Negotiated Rate $2,070.25
Rate for Payer: Aetna Commercial $645.26
Rate for Payer: Anthem Medicaid $288.19
Rate for Payer: Anthem Medicare Advantage/PPO $1,478.75
Rate for Payer: Anthem POS/PPO/Traditional $653.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,070.25
Rate for Payer: CareSource Just4Me Medicare $1,996.31
Rate for Payer: Cash Price $419.00
Rate for Payer: Cash Price $419.00
Rate for Payer: Cigna Commercial $695.54
Rate for Payer: First Health Commercial $796.10
Rate for Payer: Humana Commercial $712.30
Rate for Payer: Humana KY Medicaid $288.19
Rate for Payer: Humana Medicare Advantage $1,478.75
Rate for Payer: Kentucky WC Medicaid $291.12
Rate for Payer: Medical Mutual Of Ohio HMO $687.16
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $618.44
Rate for Payer: Molina Healthcare Benefit Exchange $1,774.50
Rate for Payer: Molina Healthcare Medicaid $293.97
Rate for Payer: Ohio Health Choice Commercial $737.44
Rate for Payer: Ohio Health Group HMO $628.50
Rate for Payer: Ohio Health Group PPO Differential $670.40
Rate for Payer: Ohio Health Group PPO No Differential $729.06
Rate for Payer: Ohio Health Group PPO SOMC Employees $578.22
Rate for Payer: PHCS Commercial $804.48
Rate for Payer: United Healthcare All Payer $737.44
Service Code HCPCS 25635
Hospital Charge Code 761P0640
Hospital Revenue Code 761
Min. Negotiated Rate $220.10
Max. Negotiated Rate $569.41
Rate for Payer: Aetna Commercial $540.85
Rate for Payer: Ambetter Exchange $409.49
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $220.10
Rate for Payer: Anthem Medicaid $224.34
Rate for Payer: Buckeye Individual/Medicaid $409.49
Rate for Payer: Buckeye Medicare Advantage $409.49
Rate for Payer: CareSource Just4Me Medicare $491.39
Rate for Payer: Cash Price $419.00
Rate for Payer: Cash Price $419.00
Rate for Payer: Cigna Commercial $569.41
Rate for Payer: Healthspan PPO $543.23
Rate for Payer: Humana Medicaid $224.34
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $485.23
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $409.49
Rate for Payer: Molina Healthcare Benefit Exchange $409.49
Rate for Payer: Molina Healthcare CHIP/Medicaid $228.83
Rate for Payer: Molina Healthcare Passport $224.34
Rate for Payer: Multiplan PHCS $502.80
Rate for Payer: Ohio Health Choice Preferred Health Choice $532.34
Rate for Payer: UHCCP Medicaid $231.10
Rate for Payer: Wellcare CHIP/Medicaid $226.58
Rate for Payer: Wellcare Medicare Advantage $409.49
Service Code HCPCS 25630
Hospital Charge Code 76100639
Hospital Revenue Code 761
Min. Negotiated Rate $146.14
Max. Negotiated Rate $958.20
Rate for Payer: Aetna Commercial $371.42
Rate for Payer: Ambetter Exchange $277.44
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $149.26
Rate for Payer: Anthem Medicaid $146.14
Rate for Payer: Buckeye Individual/Medicaid $277.44
Rate for Payer: Buckeye Medicare Advantage $277.44
Rate for Payer: CareSource Just4Me Medicare $332.93
Rate for Payer: Cash Price $798.50
Rate for Payer: Cash Price $798.50
Rate for Payer: Cigna Commercial $459.36
Rate for Payer: Healthspan PPO $369.39
Rate for Payer: Humana Medicaid $146.14
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $330.03
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $277.44
Rate for Payer: Molina Healthcare Benefit Exchange $277.44
Rate for Payer: Molina Healthcare CHIP/Medicaid $149.06
Rate for Payer: Molina Healthcare Passport $146.14
Rate for Payer: Multiplan PHCS $958.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $360.67
Rate for Payer: UHCCP Medicaid $156.72
Rate for Payer: Wellcare CHIP/Medicaid $147.60
Rate for Payer: Wellcare Medicare Advantage $277.44
Service Code HCPCS 25630
Hospital Charge Code 76100639
Hospital Revenue Code 761
Min. Negotiated Rate $221.64
Max. Negotiated Rate $1,533.12
Rate for Payer: Aetna Commercial $1,229.69
Rate for Payer: Anthem Medicaid $549.21
Rate for Payer: Anthem Medicare Advantage/PPO $221.64
Rate for Payer: Anthem POS/PPO/Traditional $1,245.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $310.30
Rate for Payer: CareSource Just4Me Medicare $299.21
Rate for Payer: Cash Price $798.50
Rate for Payer: Cash Price $798.50
Rate for Payer: Cigna Commercial $1,325.51
Rate for Payer: First Health Commercial $1,517.15
Rate for Payer: Humana Commercial $1,357.45
Rate for Payer: Humana KY Medicaid $549.21
Rate for Payer: Humana Medicare Advantage $221.64
Rate for Payer: Kentucky WC Medicaid $554.80
Rate for Payer: Medical Mutual Of Ohio HMO $1,309.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,178.59
Rate for Payer: Molina Healthcare Benefit Exchange $265.97
Rate for Payer: Molina Healthcare Medicaid $560.23
Rate for Payer: Ohio Health Choice Commercial $1,405.36
Rate for Payer: Ohio Health Group HMO $1,197.75
Rate for Payer: Ohio Health Group PPO Differential $1,277.60
Rate for Payer: Ohio Health Group PPO No Differential $1,389.39
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,101.93
Rate for Payer: PHCS Commercial $1,533.12
Rate for Payer: United Healthcare All Payer $1,405.36
Service Code HCPCS 25630
Hospital Charge Code 76100639
Hospital Revenue Code 761
Min. Negotiated Rate $479.10
Max. Negotiated Rate $1,533.12
Rate for Payer: Aetna Commercial $1,229.69
Rate for Payer: Anthem POS/PPO/Traditional $1,245.66
Rate for Payer: Cash Price $798.50
Rate for Payer: Cigna Commercial $1,325.51
Rate for Payer: First Health Commercial $1,517.15
Rate for Payer: Humana Commercial $1,357.45
Rate for Payer: Medical Mutual Of Ohio HMO $1,309.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,178.59
Rate for Payer: Molina Healthcare Benefit Exchange $479.10
Rate for Payer: Ohio Health Choice Commercial $1,405.36
Rate for Payer: Ohio Health Group HMO $1,197.75
Rate for Payer: Ohio Health Group PPO Differential $1,277.60
Rate for Payer: Ohio Health Group PPO No Differential $1,389.39
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,101.93
Rate for Payer: PHCS Commercial $1,533.12
Rate for Payer: United Healthcare All Payer $1,405.36
Service Code HCPCS 25630
Hospital Charge Code 761P0639
Hospital Revenue Code 761
Min. Negotiated Rate $146.14
Max. Negotiated Rate $459.36
Rate for Payer: Aetna Commercial $371.42
Rate for Payer: Ambetter Exchange $277.44
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $149.26
Rate for Payer: Anthem Medicaid $146.14
Rate for Payer: Buckeye Individual/Medicaid $277.44
Rate for Payer: Buckeye Medicare Advantage $277.44
Rate for Payer: CareSource Just4Me Medicare $332.93
Rate for Payer: Cash Price $319.00
Rate for Payer: Cash Price $319.00
Rate for Payer: Cigna Commercial $459.36
Rate for Payer: Healthspan PPO $369.39
Rate for Payer: Humana Medicaid $146.14
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $330.03
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $277.44
Rate for Payer: Molina Healthcare Benefit Exchange $277.44
Rate for Payer: Molina Healthcare CHIP/Medicaid $149.06
Rate for Payer: Molina Healthcare Passport $146.14
Rate for Payer: Multiplan PHCS $382.80
Rate for Payer: Ohio Health Choice Preferred Health Choice $360.67
Rate for Payer: UHCCP Medicaid $156.72
Rate for Payer: Wellcare CHIP/Medicaid $147.60
Rate for Payer: Wellcare Medicare Advantage $277.44
Service Code HCPCS 25630
Hospital Charge Code 761T0639
Hospital Revenue Code 761
Min. Negotiated Rate $287.70
Max. Negotiated Rate $920.64
Rate for Payer: Aetna Commercial $738.43
Rate for Payer: Anthem POS/PPO/Traditional $748.02
Rate for Payer: Cash Price $479.50
Rate for Payer: Cigna Commercial $795.97
Rate for Payer: First Health Commercial $911.05
Rate for Payer: Humana Commercial $815.15
Rate for Payer: Medical Mutual Of Ohio HMO $786.38
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $707.74
Rate for Payer: Molina Healthcare Benefit Exchange $287.70
Rate for Payer: Ohio Health Choice Commercial $843.92
Rate for Payer: Ohio Health Group HMO $719.25
Rate for Payer: Ohio Health Group PPO Differential $767.20
Rate for Payer: Ohio Health Group PPO No Differential $834.33
Rate for Payer: Ohio Health Group PPO SOMC Employees $661.71
Rate for Payer: PHCS Commercial $920.64
Rate for Payer: United Healthcare All Payer $843.92
Service Code HCPCS 25630
Hospital Charge Code 761T0639
Hospital Revenue Code 761
Min. Negotiated Rate $221.64
Max. Negotiated Rate $920.64
Rate for Payer: Aetna Commercial $738.43
Rate for Payer: Anthem Medicaid $329.80
Rate for Payer: Anthem Medicare Advantage/PPO $221.64
Rate for Payer: Anthem POS/PPO/Traditional $748.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $310.30
Rate for Payer: CareSource Just4Me Medicare $299.21
Rate for Payer: Cash Price $479.50
Rate for Payer: Cash Price $479.50
Rate for Payer: Cigna Commercial $795.97
Rate for Payer: First Health Commercial $911.05
Rate for Payer: Humana Commercial $815.15
Rate for Payer: Humana KY Medicaid $329.80
Rate for Payer: Humana Medicare Advantage $221.64
Rate for Payer: Kentucky WC Medicaid $333.16
Rate for Payer: Medical Mutual Of Ohio HMO $786.38
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $707.74
Rate for Payer: Molina Healthcare Benefit Exchange $265.97
Rate for Payer: Molina Healthcare Medicaid $336.42
Rate for Payer: Ohio Health Choice Commercial $843.92
Rate for Payer: Ohio Health Group HMO $719.25
Rate for Payer: Ohio Health Group PPO Differential $767.20
Rate for Payer: Ohio Health Group PPO No Differential $834.33
Rate for Payer: Ohio Health Group PPO SOMC Employees $661.71
Rate for Payer: PHCS Commercial $920.64
Rate for Payer: United Healthcare All Payer $843.92
Service Code HCPCS 25624
Hospital Charge Code 76100637
Hospital Revenue Code 761
Min. Negotiated Rate $296.44
Max. Negotiated Rate $2,070.25
Rate for Payer: Aetna Commercial $663.74
Rate for Payer: Anthem Medicaid $296.44
Rate for Payer: Anthem Medicare Advantage/PPO $1,478.75
Rate for Payer: Anthem POS/PPO/Traditional $672.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,070.25
Rate for Payer: CareSource Just4Me Medicare $1,996.31
Rate for Payer: Cash Price $431.00
Rate for Payer: Cash Price $431.00
Rate for Payer: Cigna Commercial $715.46
Rate for Payer: First Health Commercial $818.90
Rate for Payer: Humana Commercial $732.70
Rate for Payer: Humana KY Medicaid $296.44
Rate for Payer: Humana Medicare Advantage $1,478.75
Rate for Payer: Kentucky WC Medicaid $299.46
Rate for Payer: Medical Mutual Of Ohio HMO $706.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $636.16
Rate for Payer: Molina Healthcare Benefit Exchange $1,774.50
Rate for Payer: Molina Healthcare Medicaid $302.39
Rate for Payer: Ohio Health Choice Commercial $758.56
Rate for Payer: Ohio Health Group HMO $646.50
Rate for Payer: Ohio Health Group PPO Differential $689.60
Rate for Payer: Ohio Health Group PPO No Differential $749.94
Rate for Payer: Ohio Health Group PPO SOMC Employees $594.78
Rate for Payer: PHCS Commercial $827.52
Rate for Payer: United Healthcare All Payer $758.56
Service Code HCPCS 25624
Hospital Charge Code 76100637
Hospital Revenue Code 761
Min. Negotiated Rate $237.88
Max. Negotiated Rate $637.39
Rate for Payer: Aetna Commercial $582.52
Rate for Payer: Ambetter Exchange $430.74
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $239.27
Rate for Payer: Anthem Medicaid $237.88
Rate for Payer: Buckeye Individual/Medicaid $430.74
Rate for Payer: Buckeye Medicare Advantage $430.74
Rate for Payer: CareSource Just4Me Medicare $516.89
Rate for Payer: Cash Price $431.00
Rate for Payer: Cash Price $431.00
Rate for Payer: Cigna Commercial $637.39
Rate for Payer: Healthspan PPO $573.21
Rate for Payer: Humana Medicaid $237.88
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $504.02
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $430.74
Rate for Payer: Molina Healthcare Benefit Exchange $430.74
Rate for Payer: Molina Healthcare CHIP/Medicaid $242.64
Rate for Payer: Molina Healthcare Passport $237.88
Rate for Payer: Multiplan PHCS $517.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $559.96
Rate for Payer: UHCCP Medicaid $251.23
Rate for Payer: Wellcare CHIP/Medicaid $240.26
Rate for Payer: Wellcare Medicare Advantage $430.74
Service Code HCPCS 25624
Hospital Charge Code 76100637
Hospital Revenue Code 761
Min. Negotiated Rate $258.60
Max. Negotiated Rate $827.52
Rate for Payer: Aetna Commercial $663.74
Rate for Payer: Anthem POS/PPO/Traditional $672.36
Rate for Payer: Cash Price $431.00
Rate for Payer: Cigna Commercial $715.46
Rate for Payer: First Health Commercial $818.90
Rate for Payer: Humana Commercial $732.70
Rate for Payer: Medical Mutual Of Ohio HMO $706.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $636.16
Rate for Payer: Molina Healthcare Benefit Exchange $258.60
Rate for Payer: Ohio Health Choice Commercial $758.56
Rate for Payer: Ohio Health Group HMO $646.50
Rate for Payer: Ohio Health Group PPO Differential $689.60
Rate for Payer: Ohio Health Group PPO No Differential $749.94
Rate for Payer: Ohio Health Group PPO SOMC Employees $594.78
Rate for Payer: PHCS Commercial $827.52
Rate for Payer: United Healthcare All Payer $758.56
Service Code HCPCS 25624
Hospital Charge Code 761P0637
Hospital Revenue Code 761
Min. Negotiated Rate $237.88
Max. Negotiated Rate $637.39
Rate for Payer: Aetna Commercial $582.52
Rate for Payer: Ambetter Exchange $430.74
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $239.27
Rate for Payer: Anthem Medicaid $237.88
Rate for Payer: Buckeye Individual/Medicaid $430.74
Rate for Payer: Buckeye Medicare Advantage $430.74
Rate for Payer: CareSource Just4Me Medicare $516.89
Rate for Payer: Cash Price $431.00
Rate for Payer: Cash Price $431.00
Rate for Payer: Cigna Commercial $637.39
Rate for Payer: Healthspan PPO $573.21
Rate for Payer: Humana Medicaid $237.88
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $504.02
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $430.74
Rate for Payer: Molina Healthcare Benefit Exchange $430.74
Rate for Payer: Molina Healthcare CHIP/Medicaid $242.64
Rate for Payer: Molina Healthcare Passport $237.88
Rate for Payer: Multiplan PHCS $517.20
Rate for Payer: Ohio Health Choice Preferred Health Choice $559.96
Rate for Payer: UHCCP Medicaid $251.23
Rate for Payer: Wellcare CHIP/Medicaid $240.26
Rate for Payer: Wellcare Medicare Advantage $430.74
Service Code HCPCS 25622
Hospital Charge Code 76100636
Hospital Revenue Code 761
Min. Negotiated Rate $328.50
Max. Negotiated Rate $1,051.20
Rate for Payer: Aetna Commercial $843.15
Rate for Payer: Anthem POS/PPO/Traditional $854.10
Rate for Payer: Cash Price $547.50
Rate for Payer: Cigna Commercial $908.85
Rate for Payer: First Health Commercial $1,040.25
Rate for Payer: Humana Commercial $930.75
Rate for Payer: Medical Mutual Of Ohio HMO $897.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $808.11
Rate for Payer: Molina Healthcare Benefit Exchange $328.50
Rate for Payer: Ohio Health Choice Commercial $963.60
Rate for Payer: Ohio Health Group HMO $821.25
Rate for Payer: Ohio Health Group PPO Differential $876.00
Rate for Payer: Ohio Health Group PPO No Differential $952.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $755.55
Rate for Payer: PHCS Commercial $1,051.20
Rate for Payer: United Healthcare All Payer $963.60
Service Code HCPCS 25622
Hospital Charge Code 76100636
Hospital Revenue Code 761
Min. Negotiated Rate $221.64
Max. Negotiated Rate $1,051.20
Rate for Payer: Aetna Commercial $843.15
Rate for Payer: Anthem Medicaid $376.57
Rate for Payer: Anthem Medicare Advantage/PPO $221.64
Rate for Payer: Anthem POS/PPO/Traditional $854.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $310.30
Rate for Payer: CareSource Just4Me Medicare $299.21
Rate for Payer: Cash Price $547.50
Rate for Payer: Cash Price $547.50
Rate for Payer: Cigna Commercial $908.85
Rate for Payer: First Health Commercial $1,040.25
Rate for Payer: Humana Commercial $930.75
Rate for Payer: Humana KY Medicaid $376.57
Rate for Payer: Humana Medicare Advantage $221.64
Rate for Payer: Kentucky WC Medicaid $380.40
Rate for Payer: Medical Mutual Of Ohio HMO $897.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $808.11
Rate for Payer: Molina Healthcare Benefit Exchange $265.97
Rate for Payer: Molina Healthcare Medicaid $384.13
Rate for Payer: Ohio Health Choice Commercial $963.60
Rate for Payer: Ohio Health Group HMO $821.25
Rate for Payer: Ohio Health Group PPO Differential $876.00
Rate for Payer: Ohio Health Group PPO No Differential $952.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $755.55
Rate for Payer: PHCS Commercial $1,051.20
Rate for Payer: United Healthcare All Payer $963.60
Service Code HCPCS 25622
Hospital Charge Code 76100636
Hospital Revenue Code 761
Min. Negotiated Rate $140.48
Max. Negotiated Rate $657.00
Rate for Payer: Aetna Commercial $359.45
Rate for Payer: Ambetter Exchange $276.22
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $147.94
Rate for Payer: Anthem Medicaid $140.48
Rate for Payer: Buckeye Individual/Medicaid $276.22
Rate for Payer: Buckeye Medicare Advantage $276.22
Rate for Payer: CareSource Just4Me Medicare $331.46
Rate for Payer: Cash Price $547.50
Rate for Payer: Cash Price $547.50
Rate for Payer: Cigna Commercial $447.68
Rate for Payer: Healthspan PPO $359.03
Rate for Payer: Humana Medicaid $140.48
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $323.47
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $276.22
Rate for Payer: Molina Healthcare Benefit Exchange $276.22
Rate for Payer: Molina Healthcare CHIP/Medicaid $143.29
Rate for Payer: Molina Healthcare Passport $140.48
Rate for Payer: Multiplan PHCS $657.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $359.09
Rate for Payer: UHCCP Medicaid $155.34
Rate for Payer: Wellcare CHIP/Medicaid $141.88
Rate for Payer: Wellcare Medicare Advantage $276.22
Service Code HCPCS 25622
Hospital Charge Code 761P0636
Hospital Revenue Code 761
Min. Negotiated Rate $140.48
Max. Negotiated Rate $447.68
Rate for Payer: Aetna Commercial $359.45
Rate for Payer: Ambetter Exchange $276.22
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $147.94
Rate for Payer: Anthem Medicaid $140.48
Rate for Payer: Buckeye Individual/Medicaid $276.22
Rate for Payer: Buckeye Medicare Advantage $276.22
Rate for Payer: CareSource Just4Me Medicare $331.46
Rate for Payer: Cash Price $250.00
Rate for Payer: Cash Price $250.00
Rate for Payer: Cigna Commercial $447.68
Rate for Payer: Healthspan PPO $359.03
Rate for Payer: Humana Medicaid $140.48
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $323.47
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage $276.22
Rate for Payer: Molina Healthcare Benefit Exchange $276.22
Rate for Payer: Molina Healthcare CHIP/Medicaid $143.29
Rate for Payer: Molina Healthcare Passport $140.48
Rate for Payer: Multiplan PHCS $300.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $359.09
Rate for Payer: UHCCP Medicaid $155.34
Rate for Payer: Wellcare CHIP/Medicaid $141.88
Rate for Payer: Wellcare Medicare Advantage $276.22