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Service Code HCPCS 95937
Hospital Charge Code 740T0011
Hospital Revenue Code 740
Min. Negotiated Rate $28.08
Max. Negotiated Rate $207.36
Rate for Payer: Aetna Commercial $166.32
Rate for Payer: Anthem POS/PPO/Traditional $168.48
Rate for Payer: Cash Price $108.00
Rate for Payer: Cigna Commercial $179.28
Rate for Payer: First Health Commercial $205.20
Rate for Payer: Humana Commercial $183.60
Rate for Payer: Medical Mutual Of Ohio HMO $177.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $159.41
Rate for Payer: Molina Healthcare Benefit Exchange $64.80
Rate for Payer: Ohio Health Choice Commercial $190.08
Rate for Payer: Ohio Health Group HMO $162.00
Rate for Payer: Ohio Health Group PPO Differential $43.20
Rate for Payer: Ohio Health Group PPO No Differential $28.08
Rate for Payer: Ohio Health Group PPO SOMC Employees $66.96
Rate for Payer: PHCS Commercial $207.36
Rate for Payer: United Healthcare All Payer $190.08
Service Code HCPCS 95937
Hospital Charge Code 922T0018
Hospital Revenue Code 922
Min. Negotiated Rate $28.08
Max. Negotiated Rate $207.36
Rate for Payer: Aetna Commercial $166.32
Rate for Payer: Anthem Medicaid $74.28
Rate for Payer: Anthem Medicare Advantage/PPO $135.08
Rate for Payer: Anthem POS/PPO/Traditional $168.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $189.11
Rate for Payer: CareSource Just4Me Medicare $182.36
Rate for Payer: Cash Price $108.00
Rate for Payer: Cash Price $108.00
Rate for Payer: Cigna Commercial $179.28
Rate for Payer: First Health Commercial $205.20
Rate for Payer: Humana Commercial $183.60
Rate for Payer: Humana KY Medicaid $74.28
Rate for Payer: Humana Medicare Advantage $135.08
Rate for Payer: Kentucky WC Medicaid $75.04
Rate for Payer: Medical Mutual Of Ohio HMO $177.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $159.41
Rate for Payer: Molina Healthcare Benefit Exchange $162.10
Rate for Payer: Molina Healthcare Medicaid $75.77
Rate for Payer: Ohio Health Choice Commercial $190.08
Rate for Payer: Ohio Health Group HMO $162.00
Rate for Payer: Ohio Health Group PPO Differential $43.20
Rate for Payer: Ohio Health Group PPO No Differential $28.08
Rate for Payer: Ohio Health Group PPO SOMC Employees $66.96
Rate for Payer: PHCS Commercial $207.36
Rate for Payer: United Healthcare All Payer $190.08
Service Code NDC 62559063101
Hospital Charge Code 25000597
Hospital Revenue Code 637
Min. Negotiated Rate $1.23
Max. Negotiated Rate $9.05
Rate for Payer: Humana Commercial $8.02
Rate for Payer: Humana KY Medicaid $3.24
Rate for Payer: Kentucky WC Medicaid $3.28
Rate for Payer: Medical Mutual Of Ohio HMO $7.73
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $6.96
Rate for Payer: Molina Healthcare Benefit Exchange $2.83
Rate for Payer: Molina Healthcare Medicaid $3.31
Rate for Payer: Ohio Health Choice Commercial $8.30
Rate for Payer: Ohio Health Group HMO $7.07
Rate for Payer: Ohio Health Group PPO Differential $1.89
Rate for Payer: Ohio Health Group PPO No Differential $1.23
Rate for Payer: Ohio Health Group PPO SOMC Employees $2.92
Rate for Payer: PHCS Commercial $9.05
Rate for Payer: United Healthcare All Payer $8.30
Rate for Payer: Aetna Commercial $7.26
Rate for Payer: Anthem Medicaid $3.24
Rate for Payer: Anthem POS/PPO/Traditional $7.36
Rate for Payer: Cash Price $4.72
Rate for Payer: Cigna Commercial $7.83
Rate for Payer: First Health Commercial $8.96
Service Code NDC 62559063101
Hospital Charge Code 25000597
Hospital Revenue Code 637
Min. Negotiated Rate $1.23
Max. Negotiated Rate $9.05
Rate for Payer: Aetna Commercial $7.26
Rate for Payer: Anthem POS/PPO/Traditional $7.36
Rate for Payer: Cash Price $4.72
Rate for Payer: Cigna Commercial $7.83
Rate for Payer: First Health Commercial $8.96
Rate for Payer: Humana Commercial $8.02
Rate for Payer: Medical Mutual Of Ohio HMO $7.73
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $6.96
Rate for Payer: Molina Healthcare Benefit Exchange $2.83
Rate for Payer: Ohio Health Choice Commercial $8.30
Rate for Payer: Ohio Health Group HMO $7.07
Rate for Payer: Ohio Health Group PPO Differential $1.89
Rate for Payer: Ohio Health Group PPO No Differential $1.23
Rate for Payer: Ohio Health Group PPO SOMC Employees $2.92
Rate for Payer: PHCS Commercial $9.05
Rate for Payer: United Healthcare All Payer $8.30
Service Code NDC 68084084401
Hospital Charge Code 25000598
Hospital Revenue Code 637
Min. Negotiated Rate $0.66
Max. Negotiated Rate $4.86
Rate for Payer: Aetna Commercial $3.90
Rate for Payer: Anthem POS/PPO/Traditional $3.95
Rate for Payer: Cash Price $2.53
Rate for Payer: Cigna Commercial $4.20
Rate for Payer: First Health Commercial $4.81
Rate for Payer: Humana Commercial $4.30
Rate for Payer: Medical Mutual Of Ohio HMO $4.15
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.73
Rate for Payer: Molina Healthcare Benefit Exchange $1.52
Rate for Payer: Ohio Health Choice Commercial $4.45
Rate for Payer: Ohio Health Group HMO $3.80
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.57
Rate for Payer: PHCS Commercial $4.86
Rate for Payer: United Healthcare All Payer $4.45
Service Code NDC 68084084401
Hospital Charge Code 25000598
Hospital Revenue Code 637
Min. Negotiated Rate $0.66
Max. Negotiated Rate $4.86
Rate for Payer: Aetna Commercial $3.90
Rate for Payer: Anthem Medicaid $1.74
Rate for Payer: Anthem POS/PPO/Traditional $3.95
Rate for Payer: Cash Price $2.53
Rate for Payer: Cigna Commercial $4.20
Rate for Payer: First Health Commercial $4.81
Rate for Payer: Humana Commercial $4.30
Rate for Payer: Humana KY Medicaid $1.74
Rate for Payer: Kentucky WC Medicaid $1.76
Rate for Payer: Medical Mutual Of Ohio HMO $4.15
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.73
Rate for Payer: Molina Healthcare Benefit Exchange $1.52
Rate for Payer: Molina Healthcare Medicaid $1.78
Rate for Payer: Ohio Health Choice Commercial $4.45
Rate for Payer: Ohio Health Group HMO $3.80
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.57
Rate for Payer: PHCS Commercial $4.86
Rate for Payer: United Healthcare All Payer $4.45
Service Code NDC 57237017401
Hospital Charge Code 25000599
Hospital Revenue Code 637
Min. Negotiated Rate $0.56
Max. Negotiated Rate $4.17
Rate for Payer: Aetna Commercial $3.34
Rate for Payer: Anthem POS/PPO/Traditional $3.39
Rate for Payer: Cash Price $2.17
Rate for Payer: Cigna Commercial $3.60
Rate for Payer: First Health Commercial $4.12
Rate for Payer: Humana Commercial $3.69
Rate for Payer: Medical Mutual Of Ohio HMO $3.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.20
Rate for Payer: Molina Healthcare Benefit Exchange $1.30
Rate for Payer: Ohio Health Choice Commercial $3.82
Rate for Payer: Ohio Health Group HMO $3.26
Rate for Payer: Ohio Health Group PPO Differential $0.87
Rate for Payer: Ohio Health Group PPO No Differential $0.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.35
Rate for Payer: PHCS Commercial $4.17
Rate for Payer: United Healthcare All Payer $3.82
Service Code NDC 57237017401
Hospital Charge Code 25000599
Hospital Revenue Code 637
Min. Negotiated Rate $0.56
Max. Negotiated Rate $4.17
Rate for Payer: Aetna Commercial $3.34
Rate for Payer: Anthem Medicaid $1.49
Rate for Payer: Anthem POS/PPO/Traditional $3.39
Rate for Payer: Cash Price $2.17
Rate for Payer: Cigna Commercial $3.60
Rate for Payer: First Health Commercial $4.12
Rate for Payer: Humana Commercial $3.69
Rate for Payer: Humana KY Medicaid $1.49
Rate for Payer: Kentucky WC Medicaid $1.51
Rate for Payer: Medical Mutual Of Ohio HMO $3.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.20
Rate for Payer: Molina Healthcare Benefit Exchange $1.30
Rate for Payer: Molina Healthcare Medicaid $1.52
Rate for Payer: Ohio Health Choice Commercial $3.82
Rate for Payer: Ohio Health Group HMO $3.26
Rate for Payer: Ohio Health Group PPO Differential $0.87
Rate for Payer: Ohio Health Group PPO No Differential $0.56
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.35
Rate for Payer: PHCS Commercial $4.17
Rate for Payer: United Healthcare All Payer $3.82
Service Code NDC 68084069801
Hospital Charge Code 25000600
Hospital Revenue Code 637
Min. Negotiated Rate $0.61
Max. Negotiated Rate $4.50
Rate for Payer: Aetna Commercial $3.61
Rate for Payer: Anthem Medicaid $1.61
Rate for Payer: Anthem POS/PPO/Traditional $3.66
Rate for Payer: Cash Price $2.35
Rate for Payer: Cigna Commercial $3.89
Rate for Payer: First Health Commercial $4.46
Rate for Payer: Humana Commercial $3.99
Rate for Payer: Humana KY Medicaid $1.61
Rate for Payer: Kentucky WC Medicaid $1.63
Rate for Payer: Medical Mutual Of Ohio HMO $3.85
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.46
Rate for Payer: Molina Healthcare Benefit Exchange $1.41
Rate for Payer: Molina Healthcare Medicaid $1.65
Rate for Payer: Ohio Health Choice Commercial $4.13
Rate for Payer: Ohio Health Group HMO $3.52
Rate for Payer: Ohio Health Group PPO Differential $0.94
Rate for Payer: Ohio Health Group PPO No Differential $0.61
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.45
Rate for Payer: PHCS Commercial $4.50
Rate for Payer: United Healthcare All Payer $4.13
Service Code NDC 68084069801
Hospital Charge Code 25000600
Hospital Revenue Code 637
Min. Negotiated Rate $0.61
Max. Negotiated Rate $4.50
Rate for Payer: Aetna Commercial $3.61
Rate for Payer: Anthem POS/PPO/Traditional $3.66
Rate for Payer: Cash Price $2.35
Rate for Payer: Cigna Commercial $3.89
Rate for Payer: First Health Commercial $4.46
Rate for Payer: Humana Commercial $3.99
Rate for Payer: Medical Mutual Of Ohio HMO $3.85
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.46
Rate for Payer: Molina Healthcare Benefit Exchange $1.41
Rate for Payer: Ohio Health Choice Commercial $4.13
Rate for Payer: Ohio Health Group HMO $3.52
Rate for Payer: Ohio Health Group PPO Differential $0.94
Rate for Payer: Ohio Health Group PPO No Differential $0.61
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.45
Rate for Payer: PHCS Commercial $4.50
Rate for Payer: United Healthcare All Payer $4.13
Service Code NDC 68084070901
Hospital Charge Code 25000601
Hospital Revenue Code 637
Min. Negotiated Rate $0.62
Max. Negotiated Rate $4.56
Rate for Payer: Aetna Commercial $3.66
Rate for Payer: Anthem POS/PPO/Traditional $3.70
Rate for Payer: Cash Price $2.38
Rate for Payer: Cigna Commercial $3.94
Rate for Payer: First Health Commercial $4.51
Rate for Payer: Humana Commercial $4.04
Rate for Payer: Medical Mutual Of Ohio HMO $3.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.51
Rate for Payer: Molina Healthcare Benefit Exchange $1.42
Rate for Payer: Ohio Health Choice Commercial $4.18
Rate for Payer: Ohio Health Group HMO $3.56
Rate for Payer: Ohio Health Group PPO Differential $0.95
Rate for Payer: Ohio Health Group PPO No Differential $0.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.47
Rate for Payer: PHCS Commercial $4.56
Rate for Payer: United Healthcare All Payer $4.18
Service Code NDC 68084070901
Hospital Charge Code 25000601
Hospital Revenue Code 637
Min. Negotiated Rate $0.62
Max. Negotiated Rate $4.56
Rate for Payer: Aetna Commercial $3.66
Rate for Payer: Anthem Medicaid $1.63
Rate for Payer: Anthem POS/PPO/Traditional $3.70
Rate for Payer: Cash Price $2.38
Rate for Payer: Cigna Commercial $3.94
Rate for Payer: First Health Commercial $4.51
Rate for Payer: Humana Commercial $4.04
Rate for Payer: Humana KY Medicaid $1.63
Rate for Payer: Kentucky WC Medicaid $1.65
Rate for Payer: Medical Mutual Of Ohio HMO $3.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.51
Rate for Payer: Molina Healthcare Benefit Exchange $1.42
Rate for Payer: Molina Healthcare Medicaid $1.67
Rate for Payer: Ohio Health Choice Commercial $4.18
Rate for Payer: Ohio Health Group HMO $3.56
Rate for Payer: Ohio Health Group PPO Differential $0.95
Rate for Payer: Ohio Health Group PPO No Differential $0.62
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.47
Rate for Payer: PHCS Commercial $4.56
Rate for Payer: United Healthcare All Payer $4.18
Service Code NDC 60505464303
Hospital Charge Code 25000602
Hospital Revenue Code 637
Min. Negotiated Rate $0.65
Max. Negotiated Rate $4.83
Rate for Payer: Aetna Commercial $3.87
Rate for Payer: Anthem POS/PPO/Traditional $3.92
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna Commercial $4.17
Rate for Payer: First Health Commercial $4.78
Rate for Payer: Humana Commercial $4.28
Rate for Payer: Medical Mutual Of Ohio HMO $4.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.71
Rate for Payer: Molina Healthcare Benefit Exchange $1.51
Rate for Payer: Ohio Health Choice Commercial $4.43
Rate for Payer: Ohio Health Group HMO $3.77
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.56
Rate for Payer: PHCS Commercial $4.83
Rate for Payer: United Healthcare All Payer $4.43
Service Code NDC 60505464303
Hospital Charge Code 25000602
Hospital Revenue Code 637
Min. Negotiated Rate $0.65
Max. Negotiated Rate $4.83
Rate for Payer: Aetna Commercial $3.87
Rate for Payer: Anthem Medicaid $1.73
Rate for Payer: Anthem POS/PPO/Traditional $3.92
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna Commercial $4.17
Rate for Payer: First Health Commercial $4.78
Rate for Payer: Humana Commercial $4.28
Rate for Payer: Humana KY Medicaid $1.73
Rate for Payer: Kentucky WC Medicaid $1.75
Rate for Payer: Medical Mutual Of Ohio HMO $4.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.71
Rate for Payer: Molina Healthcare Benefit Exchange $1.51
Rate for Payer: Molina Healthcare Medicaid $1.76
Rate for Payer: Ohio Health Choice Commercial $4.43
Rate for Payer: Ohio Health Group HMO $3.77
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.56
Rate for Payer: PHCS Commercial $4.83
Rate for Payer: United Healthcare All Payer $4.43
Service Code NDC 60505464203
Hospital Charge Code 25000603
Hospital Revenue Code 637
Min. Negotiated Rate $0.65
Max. Negotiated Rate $4.83
Rate for Payer: Aetna Commercial $3.87
Rate for Payer: Anthem Medicaid $1.73
Rate for Payer: Anthem POS/PPO/Traditional $3.92
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna Commercial $4.17
Rate for Payer: First Health Commercial $4.78
Rate for Payer: Humana Commercial $4.28
Rate for Payer: Humana KY Medicaid $1.73
Rate for Payer: Kentucky WC Medicaid $1.75
Rate for Payer: Medical Mutual Of Ohio HMO $4.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.71
Rate for Payer: Molina Healthcare Benefit Exchange $1.51
Rate for Payer: Molina Healthcare Medicaid $1.76
Rate for Payer: Ohio Health Choice Commercial $4.43
Rate for Payer: Ohio Health Group HMO $3.77
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.56
Rate for Payer: PHCS Commercial $4.83
Rate for Payer: United Healthcare All Payer $4.43
Service Code NDC 60505464203
Hospital Charge Code 25000603
Hospital Revenue Code 637
Min. Negotiated Rate $0.65
Max. Negotiated Rate $4.83
Rate for Payer: Aetna Commercial $3.87
Rate for Payer: Anthem POS/PPO/Traditional $3.92
Rate for Payer: Cash Price $2.52
Rate for Payer: Cigna Commercial $4.17
Rate for Payer: First Health Commercial $4.78
Rate for Payer: Humana Commercial $4.28
Rate for Payer: Medical Mutual Of Ohio HMO $4.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3.71
Rate for Payer: Molina Healthcare Benefit Exchange $1.51
Rate for Payer: Ohio Health Choice Commercial $4.43
Rate for Payer: Ohio Health Group HMO $3.77
Rate for Payer: Ohio Health Group PPO Differential $1.01
Rate for Payer: Ohio Health Group PPO No Differential $0.65
Rate for Payer: Ohio Health Group PPO SOMC Employees $1.56
Rate for Payer: PHCS Commercial $4.83
Rate for Payer: United Healthcare All Payer $4.43
Service Code HCPCS 43250
Hospital Charge Code 76101746
Hospital Revenue Code 761
Min. Negotiated Rate $161.21
Max. Negotiated Rate $875.00
Rate for Payer: Aetna Commercial $286.74
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $161.21
Rate for Payer: Anthem Medicaid $227.73
Rate for Payer: Buckeye Medicare Advantage $875.00
Rate for Payer: Cash Price $437.50
Rate for Payer: Cash Price $437.50
Rate for Payer: Cigna Commercial $261.98
Rate for Payer: Healthspan PPO $241.81
Rate for Payer: Humana Medicaid $227.73
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $247.75
Rate for Payer: Molina Healthcare CHIP/Medicaid $232.28
Rate for Payer: Molina Healthcare Passport $227.73
Rate for Payer: Multiplan PHCS $525.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $612.50
Rate for Payer: UHCCP Medicaid $169.27
Rate for Payer: Wellcare CHIP/Medicaid $230.01
Service Code HCPCS 43250
Hospital Charge Code 76101746
Hospital Revenue Code 761
Min. Negotiated Rate $113.75
Max. Negotiated Rate $2,303.66
Rate for Payer: Aetna Commercial $673.75
Rate for Payer: Anthem Medicaid $300.91
Rate for Payer: Anthem Medicare Advantage/PPO $1,645.47
Rate for Payer: Anthem POS/PPO/Traditional $682.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,303.66
Rate for Payer: CareSource Just4Me Medicare $2,221.38
Rate for Payer: Cash Price $437.50
Rate for Payer: Cash Price $437.50
Rate for Payer: Cigna Commercial $726.25
Rate for Payer: First Health Commercial $831.25
Rate for Payer: Humana Commercial $743.75
Rate for Payer: Humana KY Medicaid $300.91
Rate for Payer: Humana Medicare Advantage $1,645.47
Rate for Payer: Kentucky WC Medicaid $303.98
Rate for Payer: Medical Mutual Of Ohio HMO $717.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $645.75
Rate for Payer: Molina Healthcare Benefit Exchange $1,974.56
Rate for Payer: Molina Healthcare Medicaid $306.95
Rate for Payer: Ohio Health Choice Commercial $770.00
Rate for Payer: Ohio Health Group HMO $656.25
Rate for Payer: Ohio Health Group PPO Differential $175.00
Rate for Payer: Ohio Health Group PPO No Differential $113.75
Rate for Payer: Ohio Health Group PPO SOMC Employees $271.25
Rate for Payer: PHCS Commercial $840.00
Rate for Payer: United Healthcare All Payer $770.00
Service Code HCPCS 43250
Hospital Charge Code 76101746
Hospital Revenue Code 761
Min. Negotiated Rate $113.75
Max. Negotiated Rate $840.00
Rate for Payer: Aetna Commercial $673.75
Rate for Payer: Anthem POS/PPO/Traditional $682.50
Rate for Payer: Cash Price $437.50
Rate for Payer: Cigna Commercial $726.25
Rate for Payer: First Health Commercial $831.25
Rate for Payer: Humana Commercial $743.75
Rate for Payer: Medical Mutual Of Ohio HMO $717.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $645.75
Rate for Payer: Molina Healthcare Benefit Exchange $262.50
Rate for Payer: Ohio Health Choice Commercial $770.00
Rate for Payer: Ohio Health Group HMO $656.25
Rate for Payer: Ohio Health Group PPO Differential $175.00
Rate for Payer: Ohio Health Group PPO No Differential $113.75
Rate for Payer: Ohio Health Group PPO SOMC Employees $271.25
Rate for Payer: PHCS Commercial $840.00
Rate for Payer: United Healthcare All Payer $770.00
Service Code HCPCS 43250
Hospital Charge Code 761P1746
Hospital Revenue Code 761
Min. Negotiated Rate $161.21
Max. Negotiated Rate $875.00
Rate for Payer: Aetna Commercial $286.74
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $161.21
Rate for Payer: Anthem Medicaid $227.73
Rate for Payer: Buckeye Medicare Advantage $875.00
Rate for Payer: Cash Price $437.50
Rate for Payer: Cash Price $437.50
Rate for Payer: Cigna Commercial $261.98
Rate for Payer: Healthspan PPO $241.81
Rate for Payer: Humana Medicaid $227.73
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $247.75
Rate for Payer: Molina Healthcare CHIP/Medicaid $232.28
Rate for Payer: Molina Healthcare Passport $227.73
Rate for Payer: Multiplan PHCS $525.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $612.50
Rate for Payer: UHCCP Medicaid $169.27
Rate for Payer: Wellcare CHIP/Medicaid $230.01
Service Code HCPCS 43255
Hospital Charge Code 76101749
Hospital Revenue Code 761
Min. Negotiated Rate $196.25
Max. Negotiated Rate $1,015.00
Rate for Payer: Aetna Commercial $432.67
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $196.25
Rate for Payer: Anthem Medicaid $289.35
Rate for Payer: Buckeye Medicare Advantage $1,015.00
Rate for Payer: Cash Price $507.50
Rate for Payer: Cash Price $507.50
Rate for Payer: Cigna Commercial $388.52
Rate for Payer: Healthspan PPO $364.88
Rate for Payer: Humana Medicaid $289.35
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $370.21
Rate for Payer: Molina Healthcare CHIP/Medicaid $295.14
Rate for Payer: Molina Healthcare Passport $289.35
Rate for Payer: Multiplan PHCS $609.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $710.50
Rate for Payer: UHCCP Medicaid $206.06
Rate for Payer: Wellcare CHIP/Medicaid $292.24
Service Code HCPCS 43255
Hospital Charge Code 76101749
Hospital Revenue Code 761
Min. Negotiated Rate $131.95
Max. Negotiated Rate $2,303.66
Rate for Payer: Aetna Commercial $781.55
Rate for Payer: Anthem Medicaid $349.06
Rate for Payer: Anthem Medicare Advantage/PPO $1,645.47
Rate for Payer: Anthem POS/PPO/Traditional $791.70
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $2,303.66
Rate for Payer: CareSource Just4Me Medicare $2,221.38
Rate for Payer: Cash Price $507.50
Rate for Payer: Cash Price $507.50
Rate for Payer: Cigna Commercial $842.45
Rate for Payer: First Health Commercial $964.25
Rate for Payer: Humana Commercial $862.75
Rate for Payer: Humana KY Medicaid $349.06
Rate for Payer: Humana Medicare Advantage $1,645.47
Rate for Payer: Kentucky WC Medicaid $352.61
Rate for Payer: Medical Mutual Of Ohio HMO $832.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $749.07
Rate for Payer: Molina Healthcare Benefit Exchange $1,974.56
Rate for Payer: Molina Healthcare Medicaid $356.06
Rate for Payer: Ohio Health Choice Commercial $893.20
Rate for Payer: Ohio Health Group HMO $761.25
Rate for Payer: Ohio Health Group PPO Differential $203.00
Rate for Payer: Ohio Health Group PPO No Differential $131.95
Rate for Payer: Ohio Health Group PPO SOMC Employees $314.65
Rate for Payer: PHCS Commercial $974.40
Rate for Payer: United Healthcare All Payer $893.20
Service Code HCPCS 43255
Hospital Charge Code 76101749
Hospital Revenue Code 761
Min. Negotiated Rate $131.95
Max. Negotiated Rate $974.40
Rate for Payer: Aetna Commercial $781.55
Rate for Payer: Anthem POS/PPO/Traditional $791.70
Rate for Payer: Cash Price $507.50
Rate for Payer: Cigna Commercial $842.45
Rate for Payer: First Health Commercial $964.25
Rate for Payer: Humana Commercial $862.75
Rate for Payer: Medical Mutual Of Ohio HMO $832.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $749.07
Rate for Payer: Molina Healthcare Benefit Exchange $304.50
Rate for Payer: Ohio Health Choice Commercial $893.20
Rate for Payer: Ohio Health Group HMO $761.25
Rate for Payer: Ohio Health Group PPO Differential $203.00
Rate for Payer: Ohio Health Group PPO No Differential $131.95
Rate for Payer: Ohio Health Group PPO SOMC Employees $314.65
Rate for Payer: PHCS Commercial $974.40
Rate for Payer: United Healthcare All Payer $893.20
Service Code HCPCS 43255
Hospital Charge Code 761P1749
Hospital Revenue Code 761
Min. Negotiated Rate $196.25
Max. Negotiated Rate $1,015.00
Rate for Payer: Aetna Commercial $432.67
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $196.25
Rate for Payer: Anthem Medicaid $289.35
Rate for Payer: Buckeye Medicare Advantage $1,015.00
Rate for Payer: Cash Price $507.50
Rate for Payer: Cash Price $507.50
Rate for Payer: Cigna Commercial $388.52
Rate for Payer: Healthspan PPO $364.88
Rate for Payer: Humana Medicaid $289.35
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $370.21
Rate for Payer: Molina Healthcare CHIP/Medicaid $295.14
Rate for Payer: Molina Healthcare Passport $289.35
Rate for Payer: Multiplan PHCS $609.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $710.50
Rate for Payer: UHCCP Medicaid $206.06
Rate for Payer: Wellcare CHIP/Medicaid $292.24
Service Code HCPCS 43235
Hospital Charge Code 76101736
Hospital Revenue Code 761
Min. Negotiated Rate $124.24
Max. Negotiated Rate $3,155.05
Rate for Payer: Aetna Commercial $221.09
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional $124.24
Rate for Payer: Anthem Medicaid $159.52
Rate for Payer: Buckeye Medicare Advantage $3,155.05
Rate for Payer: Cash Price $1,577.53
Rate for Payer: Cash Price $1,577.53
Rate for Payer: Cigna Commercial $198.90
Rate for Payer: Healthspan PPO $360.67
Rate for Payer: Humana Medicaid $159.52
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $190.04
Rate for Payer: Molina Healthcare CHIP/Medicaid $162.71
Rate for Payer: Molina Healthcare Passport $159.52
Rate for Payer: Multiplan PHCS $1,893.03
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,208.54
Rate for Payer: UHCCP Medicaid $130.45
Rate for Payer: Wellcare CHIP/Medicaid $161.12