CHEMICAL PEEL - FACE
|
Professional
|
Both
|
$125.00
|
|
Hospital Charge Code |
22200325
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$43.75 |
Max. Negotiated Rate |
$125.00 |
Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
Rate for Payer: Cash Price |
$62.50
|
Rate for Payer: Multiplan PHCS |
$75.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
Rate for Payer: UHCCP Medicaid |
$43.75
|
|
CHEMICAL PEEL FACIAL DERMAL
|
Facility
|
IP
|
$1,912.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
76100212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$248.56 |
Max. Negotiated Rate |
$1,835.52 |
Rate for Payer: Aetna Commercial |
$1,472.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.36
|
Rate for Payer: Cash Price |
$956.00
|
Rate for Payer: Cigna Commercial |
$1,586.96
|
Rate for Payer: First Health Commercial |
$1,816.40
|
Rate for Payer: Humana Commercial |
$1,625.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,411.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$573.60
|
Rate for Payer: Ohio Health Choice Commercial |
$1,682.56
|
Rate for Payer: Ohio Health Group HMO |
$1,434.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.72
|
Rate for Payer: PHCS Commercial |
$1,835.52
|
Rate for Payer: United Healthcare All Payer |
$1,682.56
|
|
CHEMICAL PEEL FACIAL DERMAL
|
Facility
|
OP
|
$1,912.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
76100212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$248.56 |
Max. Negotiated Rate |
$1,835.52 |
Rate for Payer: Aetna Commercial |
$1,472.24
|
Rate for Payer: Anthem Medicaid |
$657.54
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.36
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
Rate for Payer: Cash Price |
$956.00
|
Rate for Payer: Cash Price |
$956.00
|
Rate for Payer: Cigna Commercial |
$1,586.96
|
Rate for Payer: First Health Commercial |
$1,816.40
|
Rate for Payer: Humana Commercial |
$1,625.20
|
Rate for Payer: Humana KY Medicaid |
$657.54
|
Rate for Payer: Humana Medicare Advantage |
$543.11
|
Rate for Payer: Kentucky WC Medicaid |
$664.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,411.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
Rate for Payer: Molina Healthcare Medicaid |
$670.73
|
Rate for Payer: Ohio Health Choice Commercial |
$1,682.56
|
Rate for Payer: Ohio Health Group HMO |
$1,434.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.72
|
Rate for Payer: PHCS Commercial |
$1,835.52
|
Rate for Payer: United Healthcare All Payer |
$1,682.56
|
|
CHEMICAL PEEL FACIAL DERMAL
|
Professional
|
Both
|
$1,912.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
76100212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$180.23 |
Max. Negotiated Rate |
$1,912.00 |
Rate for Payer: Aetna Commercial |
$590.48
|
Rate for Payer: Anthem Medicaid |
$180.23
|
Rate for Payer: Buckeye Medicare Advantage |
$1,912.00
|
Rate for Payer: Cash Price |
$956.00
|
Rate for Payer: Cash Price |
$956.00
|
Rate for Payer: Cigna Commercial |
$734.39
|
Rate for Payer: Healthspan PPO |
$615.08
|
Rate for Payer: Humana Medicaid |
$180.23
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.19
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.83
|
Rate for Payer: Molina Healthcare Passport |
$180.23
|
Rate for Payer: Multiplan PHCS |
$1,147.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,338.40
|
Rate for Payer: UHCCP Medicaid |
$669.20
|
Rate for Payer: Wellcare CHIP/Medicaid |
$182.03
|
|
CHEMICAL PEEL FACIAL DERMAL(P
|
Professional
|
Both
|
$1,200.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
761P0212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$180.23 |
Max. Negotiated Rate |
$1,200.00 |
Rate for Payer: Aetna Commercial |
$590.48
|
Rate for Payer: Anthem Medicaid |
$180.23
|
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 |
$734.39
|
Rate for Payer: Healthspan PPO |
$615.08
|
Rate for Payer: Humana Medicaid |
$180.23
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.19
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.83
|
Rate for Payer: Molina Healthcare Passport |
$180.23
|
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 |
$182.03
|
|
CHEMICAL PEEL FACIAL DERMAL(T
|
Facility
|
IP
|
$712.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
761T0212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$92.56 |
Max. Negotiated Rate |
$683.52 |
Rate for Payer: Aetna Commercial |
$548.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
Rate for Payer: Cash Price |
$356.00
|
Rate for Payer: Cigna Commercial |
$590.96
|
Rate for Payer: First Health Commercial |
$676.40
|
Rate for Payer: Humana Commercial |
$605.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$213.60
|
Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
Rate for Payer: Ohio Health Group HMO |
$534.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$92.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.72
|
Rate for Payer: PHCS Commercial |
$683.52
|
Rate for Payer: United Healthcare All Payer |
$626.56
|
|
CHEMICAL PEEL FACIAL DERMAL(T
|
Facility
|
OP
|
$712.00
|
|
Service Code
|
HCPCS 15789
|
Hospital Charge Code |
761T0212
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$92.56 |
Max. Negotiated Rate |
$760.35 |
Rate for Payer: Aetna Commercial |
$548.24
|
Rate for Payer: Anthem Medicaid |
$244.86
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
Rate for Payer: Cash Price |
$356.00
|
Rate for Payer: Cash Price |
$356.00
|
Rate for Payer: Cigna Commercial |
$590.96
|
Rate for Payer: First Health Commercial |
$676.40
|
Rate for Payer: Humana Commercial |
$605.20
|
Rate for Payer: Humana KY Medicaid |
$244.86
|
Rate for Payer: Humana Medicare Advantage |
$543.11
|
Rate for Payer: Kentucky WC Medicaid |
$247.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
Rate for Payer: Molina Healthcare Medicaid |
$249.77
|
Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
Rate for Payer: Ohio Health Group HMO |
$534.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$92.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.72
|
Rate for Payer: PHCS Commercial |
$683.52
|
Rate for Payer: United Healthcare All Payer |
$626.56
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$1,770.63
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
76100211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$100.13 |
Max. Negotiated Rate |
$1,770.63 |
Rate for Payer: Aetna Commercial |
$324.37
|
Rate for Payer: Anthem Medicaid |
$100.13
|
Rate for Payer: Buckeye Medicare Advantage |
$1,770.63
|
Rate for Payer: Cash Price |
$885.32
|
Rate for Payer: Cash Price |
$885.32
|
Rate for Payer: Cigna Commercial |
$512.60
|
Rate for Payer: Healthspan PPO |
$454.52
|
Rate for Payer: Humana Medicaid |
$100.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.22
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.13
|
Rate for Payer: Molina Healthcare Passport |
$100.13
|
Rate for Payer: Multiplan PHCS |
$1,062.38
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,239.44
|
Rate for Payer: UHCCP Medicaid |
$619.72
|
Rate for Payer: Wellcare CHIP/Medicaid |
$101.13
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
IP
|
$1,770.63
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
76100211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$230.18 |
Max. Negotiated Rate |
$1,699.80 |
Rate for Payer: Aetna Commercial |
$1,363.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.09
|
Rate for Payer: Cash Price |
$885.32
|
Rate for Payer: Cigna Commercial |
$1,469.62
|
Rate for Payer: First Health Commercial |
$1,682.10
|
Rate for Payer: Humana Commercial |
$1,505.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$531.19
|
Rate for Payer: Ohio Health Choice Commercial |
$1,558.15
|
Rate for Payer: Ohio Health Group HMO |
$1,327.97
|
Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
Rate for Payer: Ohio Health Group PPO No Differential |
$230.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
Rate for Payer: PHCS Commercial |
$1,699.80
|
Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
OP
|
$1,770.63
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
76100211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$230.18 |
Max. Negotiated Rate |
$1,699.80 |
Rate for Payer: Aetna Commercial |
$1,363.39
|
Rate for Payer: Anthem Medicaid |
$608.92
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.09
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
Rate for Payer: Cash Price |
$885.32
|
Rate for Payer: Cash Price |
$885.32
|
Rate for Payer: Cigna Commercial |
$1,469.62
|
Rate for Payer: First Health Commercial |
$1,682.10
|
Rate for Payer: Humana Commercial |
$1,505.04
|
Rate for Payer: Humana KY Medicaid |
$608.92
|
Rate for Payer: Humana Medicare Advantage |
$344.82
|
Rate for Payer: Kentucky WC Medicaid |
$615.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
Rate for Payer: Molina Healthcare Medicaid |
$621.14
|
Rate for Payer: Ohio Health Choice Commercial |
$1,558.15
|
Rate for Payer: Ohio Health Group HMO |
$1,327.97
|
Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
Rate for Payer: Ohio Health Group PPO No Differential |
$230.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
Rate for Payer: PHCS Commercial |
$1,699.80
|
Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
IP
|
$770.63
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
761T0211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$100.18 |
Max. Negotiated Rate |
$739.80 |
Rate for Payer: Aetna Commercial |
$593.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$601.09
|
Rate for Payer: Cash Price |
$385.32
|
Rate for Payer: Cigna Commercial |
$639.62
|
Rate for Payer: First Health Commercial |
$732.10
|
Rate for Payer: Humana Commercial |
$655.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$631.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$231.19
|
Rate for Payer: Ohio Health Choice Commercial |
$678.15
|
Rate for Payer: Ohio Health Group HMO |
$577.97
|
Rate for Payer: Ohio Health Group PPO Differential |
$154.13
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.90
|
Rate for Payer: PHCS Commercial |
$739.80
|
Rate for Payer: United Healthcare All Payer |
$678.15
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$1,000.00
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
761P0211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$100.13 |
Max. Negotiated Rate |
$1,000.00 |
Rate for Payer: Aetna Commercial |
$324.37
|
Rate for Payer: Anthem Medicaid |
$100.13
|
Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
Rate for Payer: Cash Price |
$500.00
|
Rate for Payer: Cash Price |
$500.00
|
Rate for Payer: Cigna Commercial |
$512.60
|
Rate for Payer: Healthspan PPO |
$454.52
|
Rate for Payer: Humana Medicaid |
$100.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.22
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.13
|
Rate for Payer: Molina Healthcare Passport |
$100.13
|
Rate for Payer: Multiplan PHCS |
$600.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
Rate for Payer: UHCCP Medicaid |
$350.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$101.13
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
OP
|
$770.63
|
|
Service Code
|
HCPCS 15788
|
Hospital Charge Code |
761T0211
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$100.18 |
Max. Negotiated Rate |
$739.80 |
Rate for Payer: Aetna Commercial |
$593.39
|
Rate for Payer: Anthem Medicaid |
$265.02
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$601.09
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
Rate for Payer: Cash Price |
$385.32
|
Rate for Payer: Cash Price |
$385.32
|
Rate for Payer: Cigna Commercial |
$639.62
|
Rate for Payer: First Health Commercial |
$732.10
|
Rate for Payer: Humana Commercial |
$655.04
|
Rate for Payer: Humana KY Medicaid |
$265.02
|
Rate for Payer: Humana Medicare Advantage |
$344.82
|
Rate for Payer: Kentucky WC Medicaid |
$267.72
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$631.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
Rate for Payer: Molina Healthcare Medicaid |
$270.34
|
Rate for Payer: Ohio Health Choice Commercial |
$678.15
|
Rate for Payer: Ohio Health Group HMO |
$577.97
|
Rate for Payer: Ohio Health Group PPO Differential |
$154.13
|
Rate for Payer: Ohio Health Group PPO No Differential |
$100.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.90
|
Rate for Payer: PHCS Commercial |
$739.80
|
Rate for Payer: United Healthcare All Payer |
$678.15
|
|
Chemical peel, nonfacial; derm
|
Facility
|
IP
|
$780.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
761T2722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$101.40 |
Max. Negotiated Rate |
$748.80 |
Rate for Payer: Aetna Commercial |
$600.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
Rate for Payer: Cash Price |
$390.00
|
Rate for Payer: Cigna Commercial |
$647.40
|
Rate for Payer: First Health Commercial |
$741.00
|
Rate for Payer: Humana Commercial |
$663.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
Rate for Payer: Ohio Health Group HMO |
$585.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
Rate for Payer: PHCS Commercial |
$748.80
|
Rate for Payer: United Healthcare All Payer |
$686.40
|
|
Chemical peel, nonfacial; derm
|
Facility
|
OP
|
$780.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
761T2722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$101.40 |
Max. Negotiated Rate |
$748.80 |
Rate for Payer: Aetna Commercial |
$600.60
|
Rate for Payer: Anthem Medicaid |
$268.24
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
Rate for Payer: Cash Price |
$390.00
|
Rate for Payer: Cash Price |
$390.00
|
Rate for Payer: Cigna Commercial |
$647.40
|
Rate for Payer: First Health Commercial |
$741.00
|
Rate for Payer: Humana Commercial |
$663.00
|
Rate for Payer: Humana KY Medicaid |
$268.24
|
Rate for Payer: Humana Medicare Advantage |
$344.82
|
Rate for Payer: Kentucky WC Medicaid |
$270.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
Rate for Payer: Ohio Health Group HMO |
$585.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
Rate for Payer: PHCS Commercial |
$748.80
|
Rate for Payer: United Healthcare All Payer |
$686.40
|
|
Chemical peel, nonfacial; derm
|
Facility
|
OP
|
$1,440.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
76102722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$187.20 |
Max. Negotiated Rate |
$1,382.40 |
Rate for Payer: Aetna Commercial |
$1,108.80
|
Rate for Payer: Anthem Medicaid |
$495.22
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
Rate for Payer: Cash Price |
$720.00
|
Rate for Payer: Cash Price |
$720.00
|
Rate for Payer: Cigna Commercial |
$1,195.20
|
Rate for Payer: First Health Commercial |
$1,368.00
|
Rate for Payer: Humana Commercial |
$1,224.00
|
Rate for Payer: Humana KY Medicaid |
$495.22
|
Rate for Payer: Humana Medicare Advantage |
$344.82
|
Rate for Payer: Kentucky WC Medicaid |
$500.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
Rate for Payer: PHCS Commercial |
$1,382.40
|
Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
Chemical peel, nonfacial; derm
|
Professional
|
Both
|
$660.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
761P2722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$117.62 |
Max. Negotiated Rate |
$660.00 |
Rate for Payer: Aetna Commercial |
$489.90
|
Rate for Payer: Anthem Medicaid |
$117.62
|
Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cigna Commercial |
$550.25
|
Rate for Payer: Healthspan PPO |
$511.54
|
Rate for Payer: Humana Medicaid |
$117.62
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.97
|
Rate for Payer: Molina Healthcare Passport |
$117.62
|
Rate for Payer: Multiplan PHCS |
$396.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
Rate for Payer: UHCCP Medicaid |
$231.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$118.80
|
|
Chemical peel, nonfacial; derm
|
Professional
|
Both
|
$1,440.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
76102722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$117.62 |
Max. Negotiated Rate |
$1,440.00 |
Rate for Payer: Aetna Commercial |
$489.90
|
Rate for Payer: Anthem Medicaid |
$117.62
|
Rate for Payer: Buckeye Medicare Advantage |
$1,440.00
|
Rate for Payer: Cash Price |
$720.00
|
Rate for Payer: Cash Price |
$720.00
|
Rate for Payer: Cigna Commercial |
$550.25
|
Rate for Payer: Healthspan PPO |
$511.54
|
Rate for Payer: Humana Medicaid |
$117.62
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.97
|
Rate for Payer: Molina Healthcare Passport |
$117.62
|
Rate for Payer: Multiplan PHCS |
$864.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,008.00
|
Rate for Payer: UHCCP Medicaid |
$504.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$118.80
|
|
Chemical peel, nonfacial; derm
|
Facility
|
IP
|
$1,440.00
|
|
Service Code
|
HCPCS 15793
|
Hospital Charge Code |
76102722
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$187.20 |
Max. Negotiated Rate |
$1,382.40 |
Rate for Payer: Aetna Commercial |
$1,108.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
Rate for Payer: Cash Price |
$720.00
|
Rate for Payer: Cigna Commercial |
$1,195.20
|
Rate for Payer: First Health Commercial |
$1,368.00
|
Rate for Payer: Humana Commercial |
$1,224.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
Rate for Payer: PHCS Commercial |
$1,382.40
|
Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
Chemical peel, nonfacial; epid
|
Facility
|
OP
|
$670.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
761T2721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$87.10 |
Max. Negotiated Rate |
$760.35 |
Rate for Payer: Aetna Commercial |
$515.90
|
Rate for Payer: Anthem Medicaid |
$230.41
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
Rate for Payer: Cash Price |
$335.00
|
Rate for Payer: Cash Price |
$335.00
|
Rate for Payer: Cigna Commercial |
$556.10
|
Rate for Payer: First Health Commercial |
$636.50
|
Rate for Payer: Humana Commercial |
$569.50
|
Rate for Payer: Humana KY Medicaid |
$230.41
|
Rate for Payer: Humana Medicare Advantage |
$543.11
|
Rate for Payer: Kentucky WC Medicaid |
$232.76
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
Rate for Payer: Ohio Health Group HMO |
$502.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
Rate for Payer: PHCS Commercial |
$643.20
|
Rate for Payer: United Healthcare All Payer |
$589.60
|
|
Chemical peel, nonfacial; epid
|
Facility
|
OP
|
$1,220.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
76102721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$158.60 |
Max. Negotiated Rate |
$1,171.20 |
Rate for Payer: Aetna Commercial |
$939.40
|
Rate for Payer: Anthem Medicaid |
$419.56
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
Rate for Payer: Cash Price |
$610.00
|
Rate for Payer: Cash Price |
$610.00
|
Rate for Payer: Cigna Commercial |
$1,012.60
|
Rate for Payer: First Health Commercial |
$1,159.00
|
Rate for Payer: Humana Commercial |
$1,037.00
|
Rate for Payer: Humana KY Medicaid |
$419.56
|
Rate for Payer: Humana Medicare Advantage |
$543.11
|
Rate for Payer: Kentucky WC Medicaid |
$423.83
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
Rate for Payer: Ohio Health Group HMO |
$915.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
Rate for Payer: PHCS Commercial |
$1,171.20
|
Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
Chemical peel, nonfacial; epid
|
Professional
|
Both
|
$1,220.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
76102721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$65.39 |
Max. Negotiated Rate |
$1,220.00 |
Rate for Payer: Aetna Commercial |
$355.33
|
Rate for Payer: Anthem Medicaid |
$65.39
|
Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
Rate for Payer: Cash Price |
$610.00
|
Rate for Payer: Cash Price |
$610.00
|
Rate for Payer: Cigna Commercial |
$493.61
|
Rate for Payer: Healthspan PPO |
$447.18
|
Rate for Payer: Humana Medicaid |
$65.39
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.23
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.70
|
Rate for Payer: Molina Healthcare Passport |
$65.39
|
Rate for Payer: Multiplan PHCS |
$732.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
Rate for Payer: UHCCP Medicaid |
$427.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$66.04
|
|
Chemical peel, nonfacial; epid
|
Professional
|
Both
|
$500.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
761P2721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$65.39 |
Max. Negotiated Rate |
$500.00 |
Rate for Payer: Aetna Commercial |
$355.33
|
Rate for Payer: Anthem Medicaid |
$65.39
|
Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
Rate for Payer: Cash Price |
$250.00
|
Rate for Payer: Cash Price |
$250.00
|
Rate for Payer: Cigna Commercial |
$493.61
|
Rate for Payer: Healthspan PPO |
$447.18
|
Rate for Payer: Humana Medicaid |
$65.39
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.23
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.70
|
Rate for Payer: Molina Healthcare Passport |
$65.39
|
Rate for Payer: Multiplan PHCS |
$300.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
Rate for Payer: UHCCP Medicaid |
$175.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$66.04
|
|
Chemical peel, nonfacial; epid
|
Facility
|
IP
|
$670.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
761T2721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$87.10 |
Max. Negotiated Rate |
$643.20 |
Rate for Payer: Aetna Commercial |
$515.90
|
Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
Rate for Payer: Cash Price |
$335.00
|
Rate for Payer: Cigna Commercial |
$556.10
|
Rate for Payer: First Health Commercial |
$636.50
|
Rate for Payer: Humana Commercial |
$569.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
Rate for Payer: Ohio Health Group HMO |
$502.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
Rate for Payer: PHCS Commercial |
$643.20
|
Rate for Payer: United Healthcare All Payer |
$589.60
|
|
Chemical peel, nonfacial; epid
|
Facility
|
IP
|
$1,220.00
|
|
Service Code
|
HCPCS 15792
|
Hospital Charge Code |
76102721
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$158.60 |
Max. Negotiated Rate |
$1,171.20 |
Rate for Payer: Aetna Commercial |
$939.40
|
Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
Rate for Payer: Cash Price |
$610.00
|
Rate for Payer: Cigna Commercial |
$1,012.60
|
Rate for Payer: First Health Commercial |
$1,159.00
|
Rate for Payer: Humana Commercial |
$1,037.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
Rate for Payer: Ohio Health Group HMO |
$915.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
Rate for Payer: PHCS Commercial |
$1,171.20
|
Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|