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Service Code HCPCS 43632
Hospital Charge Code 76101785
Hospital Revenue Code 761
Min. Negotiated Rate $390.00
Max. Negotiated Rate $2,880.00
Rate for Payer: Aetna Commercial $2,310.00
Rate for Payer: Anthem POS/PPO/Traditional $2,340.00
Rate for Payer: Cash Price $1,500.00
Rate for Payer: Cigna Commercial $2,490.00
Rate for Payer: First Health Commercial $2,850.00
Rate for Payer: Humana Commercial $2,550.00
Rate for Payer: Medical Mutual Of Ohio HMO $2,460.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $2,214.00
Rate for Payer: Molina Healthcare Benefit Exchange $900.00
Rate for Payer: Ohio Health Choice Commercial $2,640.00
Rate for Payer: Ohio Health Group HMO $2,250.00
Rate for Payer: Ohio Health Group PPO Differential $600.00
Rate for Payer: Ohio Health Group PPO No Differential $390.00
Rate for Payer: Ohio Health Group PPO SOMC Employees $930.00
Rate for Payer: PHCS Commercial $2,880.00
Rate for Payer: United Healthcare All Payer $2,640.00
Service Code HCPCS 43632
Hospital Charge Code 761P1785
Hospital Revenue Code 761
Min. Negotiated Rate $928.88
Max. Negotiated Rate $3,000.00
Rate for Payer: Aetna Commercial $2,832.92
Rate for Payer: Anthem Medicaid $928.88
Rate for Payer: Buckeye Medicare Advantage $3,000.00
Rate for Payer: Cash Price $1,500.00
Rate for Payer: Cash Price $1,500.00
Rate for Payer: Cigna Commercial $2,563.49
Rate for Payer: Healthspan PPO $2,389.05
Rate for Payer: Humana Medicaid $928.88
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $2,584.62
Rate for Payer: Molina Healthcare CHIP/Medicaid $947.46
Rate for Payer: Molina Healthcare Passport $928.88
Rate for Payer: Multiplan PHCS $1,800.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $2,100.00
Rate for Payer: UHCCP Medicaid $1,050.00
Rate for Payer: Wellcare CHIP/Medicaid $938.17
Service Code HCPCS 78264
Hospital Charge Code 34000011
Hospital Revenue Code 340
Min. Negotiated Rate $43.45
Max. Negotiated Rate $1,906.00
Rate for Payer: Aetna Commercial $407.49
Rate for Payer: Anthem Medicaid $145.24
Rate for Payer: Buckeye Medicare Advantage $1,906.00
Rate for Payer: Cash Price $953.00
Rate for Payer: Cash Price $953.00
Rate for Payer: Cigna Commercial $330.10
Rate for Payer: Healthspan PPO $407.28
Rate for Payer: Humana Medicaid $145.24
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $43.45
Rate for Payer: Molina Healthcare CHIP/Medicaid $148.14
Rate for Payer: Molina Healthcare Passport $145.24
Rate for Payer: Multiplan PHCS $1,143.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $1,334.20
Rate for Payer: UHCCP Medicaid $667.10
Rate for Payer: Wellcare CHIP/Medicaid $146.69
Service Code HCPCS 78264
Hospital Charge Code 34000011
Hospital Revenue Code 340
Min. Negotiated Rate $247.78
Max. Negotiated Rate $1,829.76
Rate for Payer: Aetna Commercial $1,467.62
Rate for Payer: Anthem Medicaid $655.47
Rate for Payer: Anthem Medicare Advantage/PPO $356.66
Rate for Payer: Anthem POS/PPO/Traditional $1,486.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $499.32
Rate for Payer: CareSource Just4Me Medicare $481.49
Rate for Payer: Cash Price $953.00
Rate for Payer: Cash Price $953.00
Rate for Payer: Cigna Commercial $1,581.98
Rate for Payer: First Health Commercial $1,810.70
Rate for Payer: Humana Commercial $1,620.10
Rate for Payer: Humana KY Medicaid $655.47
Rate for Payer: Humana Medicare Advantage $356.66
Rate for Payer: Kentucky WC Medicaid $662.14
Rate for Payer: Medical Mutual Of Ohio HMO $1,562.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,406.63
Rate for Payer: Molina Healthcare Benefit Exchange $427.99
Rate for Payer: Molina Healthcare Medicaid $668.62
Rate for Payer: Ohio Health Choice Commercial $1,677.28
Rate for Payer: Ohio Health Group HMO $1,429.50
Rate for Payer: Ohio Health Group PPO Differential $381.20
Rate for Payer: Ohio Health Group PPO No Differential $247.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $590.86
Rate for Payer: PHCS Commercial $1,829.76
Rate for Payer: United Healthcare All Payer $1,677.28
Service Code HCPCS 78264
Hospital Charge Code 34000011
Hospital Revenue Code 340
Min. Negotiated Rate $247.78
Max. Negotiated Rate $1,829.76
Rate for Payer: Aetna Commercial $1,467.62
Rate for Payer: Anthem POS/PPO/Traditional $1,486.68
Rate for Payer: Cash Price $953.00
Rate for Payer: Cigna Commercial $1,581.98
Rate for Payer: First Health Commercial $1,810.70
Rate for Payer: Humana Commercial $1,620.10
Rate for Payer: Medical Mutual Of Ohio HMO $1,562.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,406.63
Rate for Payer: Molina Healthcare Benefit Exchange $571.80
Rate for Payer: Ohio Health Choice Commercial $1,677.28
Rate for Payer: Ohio Health Group HMO $1,429.50
Rate for Payer: Ohio Health Group PPO Differential $381.20
Rate for Payer: Ohio Health Group PPO No Differential $247.78
Rate for Payer: Ohio Health Group PPO SOMC Employees $590.86
Rate for Payer: PHCS Commercial $1,829.76
Rate for Payer: United Healthcare All Payer $1,677.28
Service Code HCPCS 78264
Hospital Charge Code 340P0011
Hospital Revenue Code 340
Min. Negotiated Rate $43.45
Max. Negotiated Rate $407.49
Rate for Payer: Aetna Commercial $407.49
Rate for Payer: Anthem Medicaid $145.24
Rate for Payer: Buckeye Medicare Advantage $150.00
Rate for Payer: Cash Price $75.00
Rate for Payer: Cash Price $75.00
Rate for Payer: Cigna Commercial $330.10
Rate for Payer: Healthspan PPO $407.28
Rate for Payer: Humana Medicaid $145.24
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $43.45
Rate for Payer: Molina Healthcare CHIP/Medicaid $148.14
Rate for Payer: Molina Healthcare Passport $145.24
Rate for Payer: Multiplan PHCS $90.00
Rate for Payer: Ohio Health Choice Preferred Health Choice $105.00
Rate for Payer: UHCCP Medicaid $52.50
Rate for Payer: Wellcare CHIP/Medicaid $146.69
Service Code HCPCS 78264
Hospital Charge Code 340T0011
Hospital Revenue Code 340
Min. Negotiated Rate $228.28
Max. Negotiated Rate $1,685.76
Rate for Payer: Aetna Commercial $1,352.12
Rate for Payer: Anthem Medicaid $603.89
Rate for Payer: Anthem Medicare Advantage/PPO $356.66
Rate for Payer: Anthem POS/PPO/Traditional $1,369.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $499.32
Rate for Payer: CareSource Just4Me Medicare $481.49
Rate for Payer: Cash Price $878.00
Rate for Payer: Cash Price $878.00
Rate for Payer: Cigna Commercial $1,457.48
Rate for Payer: First Health Commercial $1,668.20
Rate for Payer: Humana Commercial $1,492.60
Rate for Payer: Humana KY Medicaid $603.89
Rate for Payer: Humana Medicare Advantage $356.66
Rate for Payer: Kentucky WC Medicaid $610.03
Rate for Payer: Medical Mutual Of Ohio HMO $1,439.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,295.93
Rate for Payer: Molina Healthcare Benefit Exchange $427.99
Rate for Payer: Molina Healthcare Medicaid $616.00
Rate for Payer: Ohio Health Choice Commercial $1,545.28
Rate for Payer: Ohio Health Group HMO $1,317.00
Rate for Payer: Ohio Health Group PPO Differential $351.20
Rate for Payer: Ohio Health Group PPO No Differential $228.28
Rate for Payer: Ohio Health Group PPO SOMC Employees $544.36
Rate for Payer: PHCS Commercial $1,685.76
Rate for Payer: United Healthcare All Payer $1,545.28
Service Code HCPCS 78264
Hospital Charge Code 340T0011
Hospital Revenue Code 340
Min. Negotiated Rate $228.28
Max. Negotiated Rate $1,685.76
Rate for Payer: Aetna Commercial $1,352.12
Rate for Payer: Anthem POS/PPO/Traditional $1,369.68
Rate for Payer: Cash Price $878.00
Rate for Payer: Cigna Commercial $1,457.48
Rate for Payer: First Health Commercial $1,668.20
Rate for Payer: Humana Commercial $1,492.60
Rate for Payer: Medical Mutual Of Ohio HMO $1,439.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $1,295.93
Rate for Payer: Molina Healthcare Benefit Exchange $526.80
Rate for Payer: Ohio Health Choice Commercial $1,545.28
Rate for Payer: Ohio Health Group HMO $1,317.00
Rate for Payer: Ohio Health Group PPO Differential $351.20
Rate for Payer: Ohio Health Group PPO No Differential $228.28
Rate for Payer: Ohio Health Group PPO SOMC Employees $544.36
Rate for Payer: PHCS Commercial $1,685.76
Rate for Payer: United Healthcare All Payer $1,545.28
Service Code HCPCS 43753
Hospital Charge Code 45000266
Hospital Revenue Code 450
Min. Negotiated Rate $51.22
Max. Negotiated Rate $380.00
Rate for Payer: Aetna Commercial $303.38
Rate for Payer: Anthem Medicaid $135.50
Rate for Payer: Anthem Medicare Advantage/PPO $271.43
Rate for Payer: Anthem POS/PPO/Traditional $307.32
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $380.00
Rate for Payer: CareSource Just4Me Medicare $366.43
Rate for Payer: Cash Price $197.00
Rate for Payer: Cash Price $197.00
Rate for Payer: Cigna Commercial $327.02
Rate for Payer: First Health Commercial $374.30
Rate for Payer: Humana Commercial $334.90
Rate for Payer: Humana KY Medicaid $135.50
Rate for Payer: Humana Medicare Advantage $271.43
Rate for Payer: Kentucky WC Medicaid $136.88
Rate for Payer: Medical Mutual Of Ohio HMO $323.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $290.77
Rate for Payer: Molina Healthcare Benefit Exchange $325.72
Rate for Payer: Molina Healthcare Medicaid $138.22
Rate for Payer: Ohio Health Choice Commercial $346.72
Rate for Payer: Ohio Health Group HMO $295.50
Rate for Payer: Ohio Health Group PPO Differential $78.80
Rate for Payer: Ohio Health Group PPO No Differential $51.22
Rate for Payer: Ohio Health Group PPO SOMC Employees $122.14
Rate for Payer: PHCS Commercial $378.24
Rate for Payer: United Healthcare All Payer $346.72
Service Code HCPCS 43753
Hospital Charge Code 76101791
Hospital Revenue Code 761
Min. Negotiated Rate $47.19
Max. Negotiated Rate $348.48
Rate for Payer: Aetna Commercial $279.51
Rate for Payer: Anthem POS/PPO/Traditional $283.14
Rate for Payer: Cash Price $181.50
Rate for Payer: Cigna Commercial $301.29
Rate for Payer: First Health Commercial $344.85
Rate for Payer: Humana Commercial $308.55
Rate for Payer: Medical Mutual Of Ohio HMO $297.66
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $267.89
Rate for Payer: Molina Healthcare Benefit Exchange $108.90
Rate for Payer: Ohio Health Choice Commercial $319.44
Rate for Payer: Ohio Health Group HMO $272.25
Rate for Payer: Ohio Health Group PPO Differential $72.60
Rate for Payer: Ohio Health Group PPO No Differential $47.19
Rate for Payer: Ohio Health Group PPO SOMC Employees $112.53
Rate for Payer: PHCS Commercial $348.48
Rate for Payer: United Healthcare All Payer $319.44
Service Code HCPCS 43753
Hospital Charge Code 45000266
Hospital Revenue Code 450
Min. Negotiated Rate $51.22
Max. Negotiated Rate $378.24
Rate for Payer: Aetna Commercial $303.38
Rate for Payer: Anthem POS/PPO/Traditional $307.32
Rate for Payer: Cash Price $197.00
Rate for Payer: Cigna Commercial $327.02
Rate for Payer: First Health Commercial $374.30
Rate for Payer: Humana Commercial $334.90
Rate for Payer: Medical Mutual Of Ohio HMO $323.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $290.77
Rate for Payer: Molina Healthcare Benefit Exchange $118.20
Rate for Payer: Ohio Health Choice Commercial $346.72
Rate for Payer: Ohio Health Group HMO $295.50
Rate for Payer: Ohio Health Group PPO Differential $78.80
Rate for Payer: Ohio Health Group PPO No Differential $51.22
Rate for Payer: Ohio Health Group PPO SOMC Employees $122.14
Rate for Payer: PHCS Commercial $378.24
Rate for Payer: United Healthcare All Payer $346.72
Service Code HCPCS 43753
Hospital Charge Code 76101791
Hospital Revenue Code 761
Min. Negotiated Rate $47.19
Max. Negotiated Rate $380.00
Rate for Payer: Aetna Commercial $279.51
Rate for Payer: Anthem Medicaid $124.84
Rate for Payer: Anthem Medicare Advantage/PPO $271.43
Rate for Payer: Anthem POS/PPO/Traditional $283.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $380.00
Rate for Payer: CareSource Just4Me Medicare $366.43
Rate for Payer: Cash Price $181.50
Rate for Payer: Cash Price $181.50
Rate for Payer: Cigna Commercial $301.29
Rate for Payer: First Health Commercial $344.85
Rate for Payer: Humana Commercial $308.55
Rate for Payer: Humana KY Medicaid $124.84
Rate for Payer: Humana Medicare Advantage $271.43
Rate for Payer: Kentucky WC Medicaid $126.11
Rate for Payer: Medical Mutual Of Ohio HMO $297.66
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $267.89
Rate for Payer: Molina Healthcare Benefit Exchange $325.72
Rate for Payer: Molina Healthcare Medicaid $127.34
Rate for Payer: Ohio Health Choice Commercial $319.44
Rate for Payer: Ohio Health Group HMO $272.25
Rate for Payer: Ohio Health Group PPO Differential $72.60
Rate for Payer: Ohio Health Group PPO No Differential $47.19
Rate for Payer: Ohio Health Group PPO SOMC Employees $112.53
Rate for Payer: PHCS Commercial $348.48
Rate for Payer: United Healthcare All Payer $319.44
Service Code HCPCS 82271
Hospital Charge Code 30000251
Hospital Revenue Code 300
Min. Negotiated Rate $5.32
Max. Negotiated Rate $46.08
Rate for Payer: Aetna Commercial $36.96
Rate for Payer: Anthem Medicaid $5.32
Rate for Payer: Anthem Medicare Advantage/PPO $5.32
Rate for Payer: Anthem POS/PPO/Traditional $38.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $7.45
Rate for Payer: CareSource Just4Me Medicare $5.32
Rate for Payer: Cash Price $24.00
Rate for Payer: Cash Price $24.00
Rate for Payer: Cigna Commercial $39.84
Rate for Payer: First Health Commercial $45.60
Rate for Payer: Humana Commercial $40.80
Rate for Payer: Humana KY Medicaid $5.32
Rate for Payer: Humana Medicare Advantage $5.32
Rate for Payer: Kentucky WC Medicaid $5.37
Rate for Payer: Medical Mutual Of Ohio HMO $39.36
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $35.42
Rate for Payer: Molina Healthcare Benefit Exchange $6.38
Rate for Payer: Molina Healthcare Medicaid $5.43
Rate for Payer: Ohio Health Choice Commercial $42.24
Rate for Payer: Ohio Health Group HMO $36.00
Rate for Payer: Ohio Health Group PPO Differential $9.60
Rate for Payer: Ohio Health Group PPO No Differential $6.24
Rate for Payer: Ohio Health Group PPO SOMC Employees $14.88
Rate for Payer: PHCS Commercial $46.08
Rate for Payer: United Healthcare All Payer $42.24
Service Code HCPCS 82271
Hospital Charge Code 30000251
Hospital Revenue Code 300
Min. Negotiated Rate $6.24
Max. Negotiated Rate $46.08
Rate for Payer: Aetna Commercial $36.96
Rate for Payer: Anthem POS/PPO/Traditional $38.54
Rate for Payer: Cash Price $24.00
Rate for Payer: Cigna Commercial $39.84
Rate for Payer: First Health Commercial $45.60
Rate for Payer: Humana Commercial $40.80
Rate for Payer: Medical Mutual Of Ohio HMO $39.36
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $35.42
Rate for Payer: Molina Healthcare Benefit Exchange $14.40
Rate for Payer: Ohio Health Choice Commercial $42.24
Rate for Payer: Ohio Health Group HMO $36.00
Rate for Payer: Ohio Health Group PPO Differential $9.60
Rate for Payer: Ohio Health Group PPO No Differential $6.24
Rate for Payer: Ohio Health Group PPO SOMC Employees $14.88
Rate for Payer: PHCS Commercial $46.08
Rate for Payer: United Healthcare All Payer $42.24
Service Code CPT 27687
Hospital Revenue Code 360
Min. Negotiated Rate $2,799.07
Max. Negotiated Rate $3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO $2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $3,918.70
Rate for Payer: CareSource Just4Me Medicare $3,778.74
Rate for Payer: Humana Medicare Advantage $2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange $3,358.88
Service Code HCPCS 27687
Hospital Charge Code 76102648
Hospital Revenue Code 761
Min. Negotiated Rate $336.01
Max. Negotiated Rate $1,301.00
Rate for Payer: Aetna Commercial $686.42
Rate for Payer: Anthem Medicaid $336.01
Rate for Payer: Buckeye Medicare Advantage $1,301.00
Rate for Payer: Cash Price $650.50
Rate for Payer: Cash Price $650.50
Rate for Payer: Cigna Commercial $761.65
Rate for Payer: Healthspan PPO $621.75
Rate for Payer: Humana Medicaid $336.01
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation $567.06
Rate for Payer: Molina Healthcare CHIP/Medicaid $342.73
Rate for Payer: Molina Healthcare Passport $336.01
Rate for Payer: Multiplan PHCS $780.60
Rate for Payer: Ohio Health Choice Preferred Health Choice $910.70
Rate for Payer: UHCCP Medicaid $455.35
Rate for Payer: Wellcare CHIP/Medicaid $339.37
Service Code HCPCS 43999
Hospital Charge Code 76102900
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 43999
Hospital Charge Code 76102900
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 Medicaid $634.50
Rate for Payer: Anthem Medicare Advantage/PPO $783.89
Rate for Payer: Anthem POS/PPO/Traditional $1,439.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $1,097.45
Rate for Payer: CareSource Just4Me Medicare $1,058.25
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 $783.89
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 $940.67
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 43999
Hospital Charge Code 76102900
Hospital Revenue Code 761
Min. Negotiated Rate $0.60
Max. Negotiated Rate $1,845.00
Rate for Payer: Anthem Medicaid $75.00
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: Healthspan PPO $0.60
Rate for Payer: Humana Medicaid $75.00
Rate for Payer: Molina Healthcare CHIP/Medicaid $76.50
Rate for Payer: Molina Healthcare Passport $75.00
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 $75.75
Service Code HCPCS Q9963
Hospital Charge Code 25004218
Hospital Revenue Code 636
Min. Negotiated Rate $18.02
Max. Negotiated Rate $133.04
Rate for Payer: Aetna Commercial $106.71
Rate for Payer: Anthem POS/PPO/Traditional $108.09
Rate for Payer: Cash Price $69.29
Rate for Payer: Cigna Commercial $115.02
Rate for Payer: First Health Commercial $131.65
Rate for Payer: Humana Commercial $117.79
Rate for Payer: Medical Mutual Of Ohio HMO $113.64
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $102.27
Rate for Payer: Molina Healthcare Benefit Exchange $41.57
Rate for Payer: Ohio Health Choice Commercial $121.95
Rate for Payer: Ohio Health Group HMO $103.94
Rate for Payer: Ohio Health Group PPO Differential $27.72
Rate for Payer: Ohio Health Group PPO No Differential $18.02
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.96
Rate for Payer: PHCS Commercial $133.04
Rate for Payer: United Healthcare All Payer $121.95
Service Code HCPCS Q9963
Hospital Charge Code 25004218
Hospital Revenue Code 636
Min. Negotiated Rate $18.02
Max. Negotiated Rate $133.04
Rate for Payer: Humana Commercial $117.79
Rate for Payer: Humana KY Medicaid $47.66
Rate for Payer: Kentucky WC Medicaid $48.14
Rate for Payer: Medical Mutual Of Ohio HMO $113.64
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $102.27
Rate for Payer: Molina Healthcare Benefit Exchange $41.57
Rate for Payer: Molina Healthcare Medicaid $48.61
Rate for Payer: Ohio Health Choice Commercial $121.95
Rate for Payer: Ohio Health Group HMO $103.94
Rate for Payer: Ohio Health Group PPO Differential $27.72
Rate for Payer: Ohio Health Group PPO No Differential $18.02
Rate for Payer: Ohio Health Group PPO SOMC Employees $42.96
Rate for Payer: PHCS Commercial $133.04
Rate for Payer: United Healthcare All Payer $121.95
Rate for Payer: Aetna Commercial $106.71
Rate for Payer: Anthem Medicaid $47.66
Rate for Payer: Anthem POS/PPO/Traditional $108.09
Rate for Payer: Cash Price $69.29
Rate for Payer: Cigna Commercial $115.02
Rate for Payer: First Health Commercial $131.65
Service Code HCPCS Q9963
Hospital Charge Code 25003814
Hospital Revenue Code 636
Min. Negotiated Rate $68.71
Max. Negotiated Rate $507.38
Rate for Payer: Aetna Commercial $406.96
Rate for Payer: Anthem POS/PPO/Traditional $412.25
Rate for Payer: Cash Price $264.26
Rate for Payer: Cigna Commercial $438.67
Rate for Payer: First Health Commercial $502.09
Rate for Payer: Humana Commercial $449.24
Rate for Payer: Medical Mutual Of Ohio HMO $433.39
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $390.05
Rate for Payer: Molina Healthcare Benefit Exchange $158.56
Rate for Payer: Ohio Health Choice Commercial $465.10
Rate for Payer: Ohio Health Group HMO $396.39
Rate for Payer: Ohio Health Group PPO Differential $105.70
Rate for Payer: Ohio Health Group PPO No Differential $68.71
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.84
Rate for Payer: PHCS Commercial $507.38
Rate for Payer: United Healthcare All Payer $465.10
Service Code HCPCS Q9963
Hospital Charge Code 25003814
Hospital Revenue Code 636
Min. Negotiated Rate $68.71
Max. Negotiated Rate $507.38
Rate for Payer: Aetna Commercial $406.96
Rate for Payer: Anthem Medicaid $181.76
Rate for Payer: Anthem POS/PPO/Traditional $412.25
Rate for Payer: Cash Price $264.26
Rate for Payer: Cigna Commercial $438.67
Rate for Payer: First Health Commercial $502.09
Rate for Payer: Humana Commercial $449.24
Rate for Payer: Humana KY Medicaid $181.76
Rate for Payer: Kentucky WC Medicaid $183.61
Rate for Payer: Medical Mutual Of Ohio HMO $433.39
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional $390.05
Rate for Payer: Molina Healthcare Benefit Exchange $158.56
Rate for Payer: Molina Healthcare Medicaid $185.40
Rate for Payer: Ohio Health Choice Commercial $465.10
Rate for Payer: Ohio Health Group HMO $396.39
Rate for Payer: Ohio Health Group PPO Differential $105.70
Rate for Payer: Ohio Health Group PPO No Differential $68.71
Rate for Payer: Ohio Health Group PPO SOMC Employees $163.84
Rate for Payer: PHCS Commercial $507.38
Rate for Payer: United Healthcare All Payer $465.10
Service Code MSDRG 378
Min. Negotiated Rate $7,809.48
Max. Negotiated Rate $11,508.70
Rate for Payer: Anthem Medicaid $7,809.48
Rate for Payer: Anthem Medicare Advantage/PPO $8,220.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $11,508.70
Rate for Payer: CareSource Just4Me Medicare $11,097.68
Rate for Payer: Humana KY Medicaid $7,809.48
Rate for Payer: Humana Medicare Advantage $8,220.50
Rate for Payer: Kentucky WC Medicaid $7,887.57
Rate for Payer: Molina Healthcare Benefit Exchange $9,864.60
Rate for Payer: Molina Healthcare Medicaid $7,965.66
Service Code MSDRG 377
Min. Negotiated Rate $14,211.52
Max. Negotiated Rate $20,943.30
Rate for Payer: Anthem Medicaid $14,211.52
Rate for Payer: Anthem Medicare Advantage/PPO $14,959.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage $20,943.30
Rate for Payer: CareSource Just4Me Medicare $20,195.32
Rate for Payer: Humana KY Medicaid $14,211.52
Rate for Payer: Humana Medicare Advantage $14,959.50
Rate for Payer: Kentucky WC Medicaid $14,353.64
Rate for Payer: Molina Healthcare Benefit Exchange $17,951.40
Rate for Payer: Molina Healthcare Medicaid $14,495.76