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Service Code HCPCS 27025
Hospital Charge Code 76100762
Hospital Revenue Code 761
Min. Negotiated Rate $145.60
Max. Negotiated Rate $1,075.20
Rate for Payer: Aetna Commercial $862.40
Rate for Payer: Anthem Medicaid $385.17
Rate for Payer: Anthem POS/PPO/Traditional $873.60
Rate for Payer: Cash Price $560.00
Rate for Payer: Cigna Commercial $929.60
Rate for Payer: First Health Commercial $1,064.00
Rate for Payer: Humana Commercial $952.00
Rate for Payer: Humana KY Medicaid $385.17
Rate for Payer: Kentucky WC Medicaid $389.09
Rate for Payer: Medical Mutual Of Ohio HMO $918.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $826.56
Rate for Payer: Molina Healthcare Benefit Exchange $336.00
Rate for Payer: Molina Healthcare Medicaid $392.90
Rate for Payer: Ohio Health Choice Commercial $985.60
Rate for Payer: Ohio Health Group HMO $840.00
Rate for Payer: Ohio Health Group PPO Differential $224.00
Rate for Payer: Ohio Health Group PPO No Differential $145.60
Rate for Payer: Ohio Health Group PPO SOMC Employees $347.20
Rate for Payer: PHCS Commercial $1,075.20
Rate for Payer: United Healthcare All Payer $985.60
Service Code HCPCS 27025
Hospital Charge Code 76100762
Hospital Revenue Code 761
Min. Negotiated Rate $145.60
Max. Negotiated Rate $1,075.20
Rate for Payer: Aetna Commercial $862.40
Rate for Payer: Anthem POS/PPO/Traditional $873.60
Rate for Payer: Cash Price $560.00
Rate for Payer: Cigna Commercial $929.60
Rate for Payer: First Health Commercial $1,064.00
Rate for Payer: Humana Commercial $952.00
Rate for Payer: Medical Mutual Of Ohio HMO $918.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $826.56
Rate for Payer: Molina Healthcare Benefit Exchange $336.00
Rate for Payer: Ohio Health Choice Commercial $985.60
Rate for Payer: Ohio Health Group HMO $840.00
Rate for Payer: Ohio Health Group PPO Differential $224.00
Rate for Payer: Ohio Health Group PPO No Differential $145.60
Rate for Payer: Ohio Health Group PPO SOMC Employees $347.20
Rate for Payer: PHCS Commercial $1,075.20
Rate for Payer: United Healthcare All Payer $985.60
Service Code HCPCS 27025
Hospital Charge Code 76100762
Hospital Revenue Code 761
Min. Negotiated Rate $392.00
Max. Negotiated Rate $1,404.81
Rate for Payer: Aetna Commercial $1,310.51
Rate for Payer: Anthem Medicaid $487.07
Rate for Payer: Buckeye Medicare Advantage $1,120.00
Rate for Payer: Cash Price $560.00
Rate for Payer: Cash Price $560.00
Rate for Payer: Cigna Commercial $1,404.81
Rate for Payer: Healthspan PPO $1,187.04
Rate for Payer: Humana Medicaid $487.07
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,129.58
Rate for Payer: Molina Healthcare CHIP/Medicaid $496.81
Rate for Payer: Molina Healthcare Passport $487.07
Rate for Payer: Multiplan PHCS $672.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $784.00
Rate for Payer: UHCCP Medicaid $392.00
Rate for Payer: Wellcare CHIP/Medicaid $491.94
Service Code HCPCS 27025
Hospital Charge Code 761P0762
Hospital Revenue Code 761
Min. Negotiated Rate $392.00
Max. Negotiated Rate $1,404.81
Rate for Payer: Aetna Commercial $1,310.51
Rate for Payer: Anthem Medicaid $487.07
Rate for Payer: Buckeye Medicare Advantage $1,120.00
Rate for Payer: Cash Price $560.00
Rate for Payer: Cash Price $560.00
Rate for Payer: Cigna Commercial $1,404.81
Rate for Payer: Healthspan PPO $1,187.04
Rate for Payer: Humana Medicaid $487.07
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,129.58
Rate for Payer: Molina Healthcare CHIP/Medicaid $496.81
Rate for Payer: Molina Healthcare Passport $487.07
Rate for Payer: Multiplan PHCS $672.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $784.00
Rate for Payer: UHCCP Medicaid $392.00
Rate for Payer: Wellcare CHIP/Medicaid $491.94
Service Code HCPCS 26045
Hospital Charge Code 76100659
Hospital Revenue Code 761
Min. Negotiated Rate $156.00
Max. Negotiated Rate $3,918.70
Rate for Payer: Aetna Commercial $924.00
Rate for Payer: Anthem Medicaid $412.68
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Anthem POS/PPO/Traditional $936.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Cash Price $600.00
Rate for Payer: Cash Price $600.00
Rate for Payer: Cigna Commercial $996.00
Rate for Payer: First Health Commercial $1,140.00
Rate for Payer: Humana Commercial $1,020.00
Rate for Payer: Humana KY Medicaid $412.68
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Kentucky WC Medicaid $416.88
Rate for Payer: Medical Mutual Of Ohio HMO $984.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $885.60
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Rate for Payer: Molina Healthcare Medicaid $420.96
Rate for Payer: Ohio Health Choice Commercial $1,056.00
Rate for Payer: Ohio Health Group HMO $900.00
Rate for Payer: Ohio Health Group PPO Differential $240.00
Rate for Payer: Ohio Health Group PPO No Differential $156.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $372.00
Rate for Payer: PHCS Commercial $1,152.00
Rate for Payer: United Healthcare All Payer $1,056.00
Service Code HCPCS 26045
Hospital Charge Code 76100659
Hospital Revenue Code 761
Min. Negotiated Rate $156.00
Max. Negotiated Rate $1,152.00
Rate for Payer: Aetna Commercial $924.00
Rate for Payer: Anthem POS/PPO/Traditional $936.00
Rate for Payer: Cash Price $600.00
Rate for Payer: Cigna Commercial $996.00
Rate for Payer: First Health Commercial $1,140.00
Rate for Payer: Humana Commercial $1,020.00
Rate for Payer: Medical Mutual Of Ohio HMO $984.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $885.60
Rate for Payer: Molina Healthcare Benefit Exchange $360.00
Rate for Payer: Ohio Health Choice Commercial $1,056.00
Rate for Payer: Ohio Health Group HMO $900.00
Rate for Payer: Ohio Health Group PPO Differential $240.00
Rate for Payer: Ohio Health Group PPO No Differential $156.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $372.00
Rate for Payer: PHCS Commercial $1,152.00
Rate for Payer: United Healthcare All Payer $1,056.00
Service Code HCPCS 26045
Hospital Charge Code 76100659
Hospital Revenue Code 761
Min. Negotiated Rate $303.87
Max. Negotiated Rate $1,200.00
Rate for Payer: Aetna Commercial $665.73
Rate for Payer: Anthem Medicaid $303.87
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 $736.98
Rate for Payer: Healthspan PPO $603.01
Rate for Payer: Humana Medicaid $303.87
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $570.34
Rate for Payer: Molina Healthcare CHIP/Medicaid $309.95
Rate for Payer: Molina Healthcare Passport $303.87
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 $306.91
Service Code HCPCS 26045
Hospital Charge Code 761P0659
Hospital Revenue Code 761
Min. Negotiated Rate $303.87
Max. Negotiated Rate $1,200.00
Rate for Payer: Aetna Commercial $665.73
Rate for Payer: Anthem Medicaid $303.87
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 $736.98
Rate for Payer: Healthspan PPO $603.01
Rate for Payer: Humana Medicaid $303.87
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $570.34
Rate for Payer: Molina Healthcare CHIP/Medicaid $309.95
Rate for Payer: Molina Healthcare Passport $303.87
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 $306.91
Service Code HCPCS 26121
Hospital Charge Code 76100672
Hospital Revenue Code 761
Min. Negotiated Rate $213.20
Max. Negotiated Rate $3,918.70
Rate for Payer: Aetna Commercial $1,262.80
Rate for Payer: Anthem Medicaid $564.00
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Anthem POS/PPO/Traditional $1,279.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Cash Price $820.00
Rate for Payer: Cash Price $820.00
Rate for Payer: Cigna Commercial $1,361.20
Rate for Payer: First Health Commercial $1,558.00
Rate for Payer: Humana Commercial $1,394.00
Rate for Payer: Humana KY Medicaid $564.00
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Kentucky WC Medicaid $569.74
Rate for Payer: Medical Mutual Of Ohio HMO $1,344.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,210.32
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Rate for Payer: Molina Healthcare Medicaid $575.31
Rate for Payer: Ohio Health Choice Commercial $1,443.20
Rate for Payer: Ohio Health Group HMO $1,230.00
Rate for Payer: Ohio Health Group PPO Differential $328.00
Rate for Payer: Ohio Health Group PPO No Differential $213.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $508.40
Rate for Payer: PHCS Commercial $1,574.40
Rate for Payer: United Healthcare All Payer $1,443.20
Service Code HCPCS 26121
Hospital Charge Code 76100672
Hospital Revenue Code 761
Min. Negotiated Rate $213.20
Max. Negotiated Rate $1,574.40
Rate for Payer: Aetna Commercial $1,262.80
Rate for Payer: Anthem POS/PPO/Traditional $1,279.20
Rate for Payer: Cash Price $820.00
Rate for Payer: Cigna Commercial $1,361.20
Rate for Payer: First Health Commercial $1,558.00
Rate for Payer: Humana Commercial $1,394.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,344.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,210.32
Rate for Payer: Molina Healthcare Benefit Exchange $492.00
Rate for Payer: Ohio Health Choice Commercial $1,443.20
Rate for Payer: Ohio Health Group HMO $1,230.00
Rate for Payer: Ohio Health Group PPO Differential $328.00
Rate for Payer: Ohio Health Group PPO No Differential $213.20
Rate for Payer: Ohio Health Group PPO SOMC Employees $508.40
Rate for Payer: PHCS Commercial $1,574.40
Rate for Payer: United Healthcare All Payer $1,443.20
Service Code HCPCS 26121
Hospital Charge Code 76100672
Hospital Revenue Code 761
Min. Negotiated Rate $506.63
Max. Negotiated Rate $1,640.00
Rate for Payer: Aetna Commercial $859.78
Rate for Payer: Anthem Medicaid $506.63
Rate for Payer: Buckeye Medicare Advantage $1,640.00
Rate for Payer: Cash Price $820.00
Rate for Payer: Cash Price $820.00
Rate for Payer: Cigna Commercial $950.36
Rate for Payer: Healthspan PPO $778.78
Rate for Payer: Humana Medicaid $506.63
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $733.66
Rate for Payer: Molina Healthcare CHIP/Medicaid $516.76
Rate for Payer: Molina Healthcare Passport $506.63
Rate for Payer: Multiplan PHCS $984.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,148.00
Rate for Payer: UHCCP Medicaid $574.00
Rate for Payer: Wellcare CHIP/Medicaid $511.70
Service Code HCPCS 26121
Hospital Charge Code 761P0672
Hospital Revenue Code 761
Min. Negotiated Rate $506.63
Max. Negotiated Rate $1,640.00
Rate for Payer: Aetna Commercial $859.78
Rate for Payer: Anthem Medicaid $506.63
Rate for Payer: Buckeye Medicare Advantage $1,640.00
Rate for Payer: Cash Price $820.00
Rate for Payer: Cash Price $820.00
Rate for Payer: Cigna Commercial $950.36
Rate for Payer: Healthspan PPO $778.78
Rate for Payer: Humana Medicaid $506.63
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $733.66
Rate for Payer: Molina Healthcare CHIP/Medicaid $516.76
Rate for Payer: Molina Healthcare Passport $506.63
Rate for Payer: Multiplan PHCS $984.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,148.00
Rate for Payer: UHCCP Medicaid $574.00
Rate for Payer: Wellcare CHIP/Medicaid $511.70
Service Code HCPCS 26123
Hospital Charge Code 76100673
Hospital Revenue Code 761
Min. Negotiated Rate $260.00
Max. Negotiated Rate $1,920.00
Rate for Payer: Aetna Commercial $1,540.00
Rate for Payer: Anthem POS/PPO/Traditional $1,560.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,660.00
Rate for Payer: First Health Commercial $1,900.00
Rate for Payer: Humana Commercial $1,700.00
Rate for Payer: Medical Mutual Of Ohio HMO $1,640.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,476.00
Rate for Payer: Molina Healthcare Benefit Exchange $600.00
Rate for Payer: Ohio Health Choice Commercial $1,760.00
Rate for Payer: Ohio Health Group HMO $1,500.00
Rate for Payer: Ohio Health Group PPO Differential $400.00
Rate for Payer: Ohio Health Group PPO No Differential $260.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $620.00
Rate for Payer: PHCS Commercial $1,920.00
Rate for Payer: United Healthcare All Payer $1,760.00
Service Code HCPCS 26123
Hospital Charge Code 761P0673
Hospital Revenue Code 761
Min. Negotiated Rate $534.78
Max. Negotiated Rate $2,000.00
Rate for Payer: Aetna Commercial $1,171.45
Rate for Payer: Anthem Medicaid $534.78
Rate for Payer: Buckeye Medicare Advantage $2,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,273.22
Rate for Payer: Healthspan PPO $1,061.08
Rate for Payer: Humana Medicaid $534.78
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,019.42
Rate for Payer: Molina Healthcare CHIP/Medicaid $545.48
Rate for Payer: Molina Healthcare Passport $534.78
Rate for Payer: Multiplan PHCS $1,200.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,400.00
Rate for Payer: UHCCP Medicaid $700.00
Rate for Payer: Wellcare CHIP/Medicaid $540.13
Service Code HCPCS 26123
Hospital Charge Code 76100673
Hospital Revenue Code 761
Min. Negotiated Rate $534.78
Max. Negotiated Rate $2,000.00
Rate for Payer: Aetna Commercial $1,171.45
Rate for Payer: Anthem Medicaid $534.78
Rate for Payer: Buckeye Medicare Advantage $2,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,273.22
Rate for Payer: Healthspan PPO $1,061.08
Rate for Payer: Humana Medicaid $534.78
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $1,019.42
Rate for Payer: Molina Healthcare CHIP/Medicaid $545.48
Rate for Payer: Molina Healthcare Passport $534.78
Rate for Payer: Multiplan PHCS $1,200.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,400.00
Rate for Payer: UHCCP Medicaid $700.00
Rate for Payer: Wellcare CHIP/Medicaid $540.13
Service Code HCPCS 26123
Hospital Charge Code 76100673
Hospital Revenue Code 761
Min. Negotiated Rate $260.00
Max. Negotiated Rate $3,918.70
Rate for Payer: Aetna Commercial $1,540.00
Rate for Payer: Anthem Medicaid $687.80
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Anthem POS/PPO/Traditional $1,560.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cash Price $1,000.00
Rate for Payer: Cigna Commercial $1,660.00
Rate for Payer: First Health Commercial $1,900.00
Rate for Payer: Humana Commercial $1,700.00
Rate for Payer: Humana KY Medicaid $687.80
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Kentucky WC Medicaid $694.80
Rate for Payer: Medical Mutual Of Ohio HMO $1,640.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,476.00
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Rate for Payer: Molina Healthcare Medicaid $701.60
Rate for Payer: Ohio Health Choice Commercial $1,760.00
Rate for Payer: Ohio Health Group HMO $1,500.00
Rate for Payer: Ohio Health Group PPO Differential $400.00
Rate for Payer: Ohio Health Group PPO No Differential $260.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $620.00
Rate for Payer: PHCS Commercial $1,920.00
Rate for Payer: United Healthcare All Payer $1,760.00
Service Code HCPCS J0517
Hospital Charge Code 25001889
Hospital Revenue Code 636
Min. Negotiated Rate $169.50
Max. Negotiated Rate $29,700.76
Rate for Payer: Aetna Commercial $23,822.48
Rate for Payer: Anthem Medicaid $10,639.68
Rate for Payer: Anthem Medicare Advantage/PPO $169.50
Rate for Payer: Anthem POS/PPO/Traditional $24,131.87
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $237.30
Rate for Payer: CareSource Just4Me Medicare $228.83
Rate for Payer: Cash Price $15,469.15
Rate for Payer: Cash Price $15,469.15
Rate for Payer: Cigna Commercial $25,678.78
Rate for Payer: First Health Commercial $29,391.38
Rate for Payer: Humana Commercial $26,297.55
Rate for Payer: Humana KY Medicaid $10,639.68
Rate for Payer: Humana Medicare Advantage $169.50
Rate for Payer: Kentucky WC Medicaid $10,747.96
Rate for Payer: Medical Mutual Of Ohio HMO $25,369.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $22,832.46
Rate for Payer: Molina Healthcare Benefit Exchange $203.40
Rate for Payer: Molina Healthcare Medicaid $10,853.15
Rate for Payer: Ohio Health Choice Commercial $27,225.70
Rate for Payer: Ohio Health Group HMO $23,203.72
Rate for Payer: Ohio Health Group PPO Differential $6,187.66
Rate for Payer: Ohio Health Group PPO No Differential $4,021.98
Rate for Payer: Ohio Health Group PPO SOMC Employees $9,590.87
Rate for Payer: PHCS Commercial $29,700.76
Rate for Payer: United Healthcare All Payer $27,225.70
Service Code HCPCS J0517
Hospital Charge Code 25001889
Hospital Revenue Code 636
Min. Negotiated Rate $4,021.98
Max. Negotiated Rate $29,700.76
Rate for Payer: Aetna Commercial $23,822.48
Rate for Payer: Anthem POS/PPO/Traditional $24,131.87
Rate for Payer: Cash Price $15,469.15
Rate for Payer: Cigna Commercial $25,678.78
Rate for Payer: First Health Commercial $29,391.38
Rate for Payer: Humana Commercial $26,297.55
Rate for Payer: Medical Mutual Of Ohio HMO $25,369.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $22,832.46
Rate for Payer: Molina Healthcare Benefit Exchange $9,281.49
Rate for Payer: Ohio Health Choice Commercial $27,225.70
Rate for Payer: Ohio Health Group HMO $23,203.72
Rate for Payer: Ohio Health Group PPO Differential $6,187.66
Rate for Payer: Ohio Health Group PPO No Differential $4,021.98
Rate for Payer: Ohio Health Group PPO SOMC Employees $9,590.87
Rate for Payer: PHCS Commercial $29,700.76
Rate for Payer: United Healthcare All Payer $27,225.70
Service Code HCPCS J9395
Hospital Charge Code 25002693
Hospital Revenue Code 636
Min. Negotiated Rate $8.44
Max. Negotiated Rate $1,835.07
Rate for Payer: Aetna Commercial $1,471.88
Rate for Payer: Anthem Medicaid $657.38
Rate for Payer: Anthem Medicare Advantage/PPO $8.44
Rate for Payer: Anthem POS/PPO/Traditional $1,490.99
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $11.82
Rate for Payer: CareSource Just4Me Medicare $11.40
Rate for Payer: Cash Price $955.76
Rate for Payer: Cash Price $955.76
Rate for Payer: Cigna Commercial $1,586.57
Rate for Payer: First Health Commercial $1,815.95
Rate for Payer: Humana Commercial $1,624.80
Rate for Payer: Humana KY Medicaid $657.38
Rate for Payer: Humana Medicare Advantage $8.44
Rate for Payer: Kentucky WC Medicaid $664.07
Rate for Payer: Medical Mutual Of Ohio HMO $1,567.45
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,410.71
Rate for Payer: Molina Healthcare Benefit Exchange $10.13
Rate for Payer: Molina Healthcare Medicaid $670.56
Rate for Payer: Ohio Health Choice Commercial $1,682.15
Rate for Payer: Ohio Health Group HMO $1,433.65
Rate for Payer: Ohio Health Group PPO Differential $382.31
Rate for Payer: Ohio Health Group PPO No Differential $248.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $592.57
Rate for Payer: PHCS Commercial $1,835.07
Rate for Payer: United Healthcare All Payer $1,682.15
Service Code HCPCS J9395
Hospital Charge Code 25002693
Hospital Revenue Code 636
Min. Negotiated Rate $248.50
Max. Negotiated Rate $1,835.07
Rate for Payer: Aetna Commercial $1,471.88
Rate for Payer: Anthem POS/PPO/Traditional $1,490.99
Rate for Payer: Cash Price $955.76
Rate for Payer: Cigna Commercial $1,586.57
Rate for Payer: First Health Commercial $1,815.95
Rate for Payer: Humana Commercial $1,624.80
Rate for Payer: Medical Mutual Of Ohio HMO $1,567.45
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,410.71
Rate for Payer: Molina Healthcare Benefit Exchange $573.46
Rate for Payer: Ohio Health Choice Commercial $1,682.15
Rate for Payer: Ohio Health Group HMO $1,433.65
Rate for Payer: Ohio Health Group PPO Differential $382.31
Rate for Payer: Ohio Health Group PPO No Differential $248.50
Rate for Payer: Ohio Health Group PPO SOMC Employees $592.57
Rate for Payer: PHCS Commercial $1,835.07
Rate for Payer: United Healthcare All Payer $1,682.15
Service Code HCPCS C1894
Hospital Charge Code 27000113
Hospital Revenue Code 272
Min. Negotiated Rate $62.66
Max. Negotiated Rate $462.72
Rate for Payer: Aetna Commercial $371.14
Rate for Payer: Anthem Medicaid $165.76
Rate for Payer: Anthem POS/PPO/Traditional $375.96
Rate for Payer: Cash Price $241.00
Rate for Payer: Cigna Commercial $400.06
Rate for Payer: First Health Commercial $457.90
Rate for Payer: Humana Commercial $409.70
Rate for Payer: Humana KY Medicaid $165.76
Rate for Payer: Kentucky WC Medicaid $167.45
Rate for Payer: Medical Mutual Of Ohio HMO $395.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $355.72
Rate for Payer: Molina Healthcare Benefit Exchange $144.60
Rate for Payer: Molina Healthcare Medicaid $169.09
Rate for Payer: Ohio Health Choice Commercial $424.16
Rate for Payer: Ohio Health Group HMO $361.50
Rate for Payer: Ohio Health Group PPO Differential $96.40
Rate for Payer: Ohio Health Group PPO No Differential $62.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $149.42
Rate for Payer: PHCS Commercial $462.72
Rate for Payer: United Healthcare All Payer $424.16
Service Code HCPCS C1894
Hospital Charge Code 27000113
Hospital Revenue Code 272
Min. Negotiated Rate $62.66
Max. Negotiated Rate $462.72
Rate for Payer: Aetna Commercial $371.14
Rate for Payer: Anthem POS/PPO/Traditional $375.96
Rate for Payer: Cash Price $241.00
Rate for Payer: Cigna Commercial $400.06
Rate for Payer: First Health Commercial $457.90
Rate for Payer: Humana Commercial $409.70
Rate for Payer: Medical Mutual Of Ohio HMO $395.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $355.72
Rate for Payer: Molina Healthcare Benefit Exchange $144.60
Rate for Payer: Ohio Health Choice Commercial $424.16
Rate for Payer: Ohio Health Group HMO $361.50
Rate for Payer: Ohio Health Group PPO Differential $96.40
Rate for Payer: Ohio Health Group PPO No Differential $62.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $149.42
Rate for Payer: PHCS Commercial $462.72
Rate for Payer: United Healthcare All Payer $424.16
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $2,415.66
Max. Negotiated Rate $17,838.72
Rate for Payer: Aetna Commercial $14,308.14
Rate for Payer: Anthem POS/PPO/Traditional $14,493.96
Rate for Payer: Cash Price $9,291.00
Rate for Payer: Cigna Commercial $15,423.06
Rate for Payer: First Health Commercial $17,652.90
Rate for Payer: Humana Commercial $15,794.70
Rate for Payer: Medical Mutual Of Ohio HMO $15,237.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $13,713.52
Rate for Payer: Molina Healthcare Benefit Exchange $5,574.60
Rate for Payer: Ohio Health Choice Commercial $16,352.16
Rate for Payer: Ohio Health Group HMO $13,936.50
Rate for Payer: Ohio Health Group PPO Differential $3,716.40
Rate for Payer: Ohio Health Group PPO No Differential $2,415.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $5,760.42
Rate for Payer: PHCS Commercial $17,838.72
Rate for Payer: United Healthcare All Payer $16,352.16
Service Code HCPCS C1776
Hospital Charge Code 27000011
Hospital Revenue Code 278
Min. Negotiated Rate $2,415.66
Max. Negotiated Rate $17,838.72
Rate for Payer: Aetna Commercial $14,308.14
Rate for Payer: Anthem Medicaid $6,390.35
Rate for Payer: Anthem POS/PPO/Traditional $14,493.96
Rate for Payer: Cash Price $9,291.00
Rate for Payer: Cigna Commercial $15,423.06
Rate for Payer: First Health Commercial $17,652.90
Rate for Payer: Humana Commercial $15,794.70
Rate for Payer: Humana KY Medicaid $6,390.35
Rate for Payer: Kentucky WC Medicaid $6,455.39
Rate for Payer: Medical Mutual Of Ohio HMO $15,237.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $13,713.52
Rate for Payer: Molina Healthcare Benefit Exchange $5,574.60
Rate for Payer: Molina Healthcare Medicaid $6,518.57
Rate for Payer: Ohio Health Choice Commercial $16,352.16
Rate for Payer: Ohio Health Group HMO $13,936.50
Rate for Payer: Ohio Health Group PPO Differential $3,716.40
Rate for Payer: Ohio Health Group PPO No Differential $2,415.66
Rate for Payer: Ohio Health Group PPO SOMC Employees $5,760.42
Rate for Payer: PHCS Commercial $17,838.72
Rate for Payer: United Healthcare All Payer $16,352.16
Service Code HCPCS C1886
Hospital Charge Code 27000013
Hospital Revenue Code 272
Min. Negotiated Rate $566.28
Max. Negotiated Rate $4,181.76
Rate for Payer: Aetna Commercial $3,354.12
Rate for Payer: Anthem Medicaid $1,498.03
Rate for Payer: Anthem POS/PPO/Traditional $3,397.68
Rate for Payer: Cash Price $2,178.00
Rate for Payer: Cigna Commercial $3,615.48
Rate for Payer: First Health Commercial $4,138.20
Rate for Payer: Humana Commercial $3,702.60
Rate for Payer: Humana KY Medicaid $1,498.03
Rate for Payer: Kentucky WC Medicaid $1,513.27
Rate for Payer: Medical Mutual Of Ohio HMO $3,571.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $3,214.73
Rate for Payer: Molina Healthcare Benefit Exchange $1,306.80
Rate for Payer: Molina Healthcare Medicaid $1,528.08
Rate for Payer: Ohio Health Choice Commercial $3,833.28
Rate for Payer: Ohio Health Group HMO $3,267.00
Rate for Payer: Ohio Health Group PPO Differential $871.20
Rate for Payer: Ohio Health Group PPO No Differential $566.28
Rate for Payer: Ohio Health Group PPO SOMC Employees $1,350.36
Rate for Payer: PHCS Commercial $4,181.76
Rate for Payer: United Healthcare All Payer $3,833.28