CHEMICAL PLEURODESIS
|
Facility
|
OP
|
$2,824.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
76101204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$367.12 |
Max. Negotiated Rate |
$2,711.04 |
Rate for Payer: Aetna Commercial |
$2,174.48
|
Rate for Payer: Anthem Medicaid |
$971.17
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,202.72
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
Rate for Payer: Cash Price |
$1,412.00
|
Rate for Payer: Cash Price |
$1,412.00
|
Rate for Payer: Cigna Commercial |
$2,343.92
|
Rate for Payer: First Health Commercial |
$2,682.80
|
Rate for Payer: Humana Commercial |
$2,400.40
|
Rate for Payer: Humana KY Medicaid |
$971.17
|
Rate for Payer: Humana Medicare Advantage |
$543.24
|
Rate for Payer: Kentucky WC Medicaid |
$981.06
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,315.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
Rate for Payer: Molina Healthcare Medicaid |
$990.66
|
Rate for Payer: Ohio Health Choice Commercial |
$2,485.12
|
Rate for Payer: Ohio Health Group HMO |
$2,118.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$564.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$367.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.44
|
Rate for Payer: PHCS Commercial |
$2,711.04
|
Rate for Payer: United Healthcare All Payer |
$2,485.12
|
|
CHEMICAL PLEURODESIS
|
Professional
|
Both
|
$2,824.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
76101204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$39.11 |
Max. Negotiated Rate |
$2,824.00 |
Rate for Payer: Aetna Commercial |
$191.82
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.11
|
Rate for Payer: Anthem Medicaid |
$89.01
|
Rate for Payer: Buckeye Medicare Advantage |
$2,824.00
|
Rate for Payer: Cash Price |
$1,412.00
|
Rate for Payer: Cash Price |
$1,412.00
|
Rate for Payer: Cigna Commercial |
$176.38
|
Rate for Payer: Healthspan PPO |
$362.35
|
Rate for Payer: Humana Medicaid |
$89.01
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.16
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.79
|
Rate for Payer: Molina Healthcare Passport |
$89.01
|
Rate for Payer: Multiplan PHCS |
$1,694.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,976.80
|
Rate for Payer: UHCCP Medicaid |
$41.07
|
Rate for Payer: Wellcare CHIP/Medicaid |
$89.90
|
|
CHEMICAL PLEURODESIS
|
Facility
|
IP
|
$2,824.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
76101204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$367.12 |
Max. Negotiated Rate |
$2,711.04 |
Rate for Payer: Aetna Commercial |
$2,174.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,202.72
|
Rate for Payer: Cash Price |
$1,412.00
|
Rate for Payer: Cigna Commercial |
$2,343.92
|
Rate for Payer: First Health Commercial |
$2,682.80
|
Rate for Payer: Humana Commercial |
$2,400.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,315.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$847.20
|
Rate for Payer: Ohio Health Choice Commercial |
$2,485.12
|
Rate for Payer: Ohio Health Group HMO |
$2,118.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$564.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$367.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.44
|
Rate for Payer: PHCS Commercial |
$2,711.04
|
Rate for Payer: United Healthcare All Payer |
$2,485.12
|
|
CHEMICAL PLEURODESIS(P
|
Professional
|
Both
|
$750.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
761P1204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$39.11 |
Max. Negotiated Rate |
$750.00 |
Rate for Payer: Aetna Commercial |
$191.82
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.11
|
Rate for Payer: Anthem Medicaid |
$89.01
|
Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cigna Commercial |
$176.38
|
Rate for Payer: Healthspan PPO |
$362.35
|
Rate for Payer: Humana Medicaid |
$89.01
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.16
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.79
|
Rate for Payer: Molina Healthcare Passport |
$89.01
|
Rate for Payer: Multiplan PHCS |
$450.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
Rate for Payer: UHCCP Medicaid |
$41.07
|
Rate for Payer: Wellcare CHIP/Medicaid |
$89.90
|
|
CHEMICAL PLEURODESIS(T
|
Facility
|
OP
|
$2,074.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
761T1204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$269.62 |
Max. Negotiated Rate |
$1,991.04 |
Rate for Payer: Aetna Commercial |
$1,596.98
|
Rate for Payer: Anthem Medicaid |
$713.25
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,617.72
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
Rate for Payer: Cash Price |
$1,037.00
|
Rate for Payer: Cash Price |
$1,037.00
|
Rate for Payer: Cigna Commercial |
$1,721.42
|
Rate for Payer: First Health Commercial |
$1,970.30
|
Rate for Payer: Humana Commercial |
$1,762.90
|
Rate for Payer: Humana KY Medicaid |
$713.25
|
Rate for Payer: Humana Medicare Advantage |
$543.24
|
Rate for Payer: Kentucky WC Medicaid |
$720.51
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,700.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,530.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
Rate for Payer: Molina Healthcare Medicaid |
$727.56
|
Rate for Payer: Ohio Health Choice Commercial |
$1,825.12
|
Rate for Payer: Ohio Health Group HMO |
$1,555.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$414.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$269.62
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.94
|
Rate for Payer: PHCS Commercial |
$1,991.04
|
Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
CHEMICAL PLEURODESIS(T
|
Facility
|
IP
|
$2,074.00
|
|
Service Code
|
HCPCS 32560
|
Hospital Charge Code |
761T1204
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$269.62 |
Max. Negotiated Rate |
$1,991.04 |
Rate for Payer: Aetna Commercial |
$1,596.98
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,617.72
|
Rate for Payer: Cash Price |
$1,037.00
|
Rate for Payer: Cigna Commercial |
$1,721.42
|
Rate for Payer: First Health Commercial |
$1,970.30
|
Rate for Payer: Humana Commercial |
$1,762.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,700.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,530.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$622.20
|
Rate for Payer: Ohio Health Choice Commercial |
$1,825.12
|
Rate for Payer: Ohio Health Group HMO |
$1,555.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$414.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$269.62
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.94
|
Rate for Payer: PHCS Commercial |
$1,991.04
|
Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
CHEM INJ OMAYA RESERVOIR
|
Facility
|
OP
|
$714.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
76102498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$92.82 |
Max. Negotiated Rate |
$685.44 |
Rate for Payer: Aetna Commercial |
$549.78
|
Rate for Payer: Anthem Medicaid |
$245.54
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
Rate for Payer: Cash Price |
$357.00
|
Rate for Payer: Cash Price |
$357.00
|
Rate for Payer: Cigna Commercial |
$592.62
|
Rate for Payer: First Health Commercial |
$678.30
|
Rate for Payer: Humana Commercial |
$606.90
|
Rate for Payer: Humana KY Medicaid |
$245.54
|
Rate for Payer: Humana Medicare Advantage |
$292.86
|
Rate for Payer: Kentucky WC Medicaid |
$248.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
Rate for Payer: Molina Healthcare Medicaid |
$250.47
|
Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
Rate for Payer: Ohio Health Group HMO |
$535.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$142.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$92.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.34
|
Rate for Payer: PHCS Commercial |
$685.44
|
Rate for Payer: United Healthcare All Payer |
$628.32
|
|
CHEM INJ OMAYA RESERVOIR
|
Facility
|
IP
|
$714.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
76102498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$92.82 |
Max. Negotiated Rate |
$685.44 |
Rate for Payer: Aetna Commercial |
$549.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
Rate for Payer: Cash Price |
$357.00
|
Rate for Payer: Cigna Commercial |
$592.62
|
Rate for Payer: First Health Commercial |
$678.30
|
Rate for Payer: Humana Commercial |
$606.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$214.20
|
Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
Rate for Payer: Ohio Health Group HMO |
$535.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$142.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$92.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.34
|
Rate for Payer: PHCS Commercial |
$685.44
|
Rate for Payer: United Healthcare All Payer |
$628.32
|
|
CHEM INJ OMAYA RESERVOIR
|
Professional
|
Both
|
$714.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
76102498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$21.46 |
Max. Negotiated Rate |
$714.00 |
Rate for Payer: Aetna Commercial |
$71.83
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.46
|
Rate for Payer: Anthem Medicaid |
$43.14
|
Rate for Payer: Buckeye Medicare Advantage |
$714.00
|
Rate for Payer: Cash Price |
$357.00
|
Rate for Payer: Cash Price |
$357.00
|
Rate for Payer: Cigna Commercial |
$274.96
|
Rate for Payer: Healthspan PPO |
$190.68
|
Rate for Payer: Humana Medicaid |
$43.14
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.72
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.00
|
Rate for Payer: Molina Healthcare Passport |
$43.14
|
Rate for Payer: Multiplan PHCS |
$428.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$499.80
|
Rate for Payer: UHCCP Medicaid |
$22.53
|
Rate for Payer: Wellcare CHIP/Medicaid |
$43.57
|
|
CHEM INJ OMAYA RESERVOIR(P
|
Professional
|
Both
|
$400.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
761P2498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$21.46 |
Max. Negotiated Rate |
$400.00 |
Rate for Payer: Aetna Commercial |
$71.83
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.46
|
Rate for Payer: Anthem Medicaid |
$43.14
|
Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
Rate for Payer: Cash Price |
$200.00
|
Rate for Payer: Cash Price |
$200.00
|
Rate for Payer: Cigna Commercial |
$274.96
|
Rate for Payer: Healthspan PPO |
$190.68
|
Rate for Payer: Humana Medicaid |
$43.14
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.72
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.00
|
Rate for Payer: Molina Healthcare Passport |
$43.14
|
Rate for Payer: Multiplan PHCS |
$240.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
Rate for Payer: UHCCP Medicaid |
$22.53
|
Rate for Payer: Wellcare CHIP/Medicaid |
$43.57
|
|
CHEM INJ OMAYA RESERVOIR(T
|
Facility
|
OP
|
$314.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
761T2498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$40.82 |
Max. Negotiated Rate |
$410.00 |
Rate for Payer: Aetna Commercial |
$241.78
|
Rate for Payer: Anthem Medicaid |
$107.98
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
Rate for Payer: Cash Price |
$157.00
|
Rate for Payer: Cash Price |
$157.00
|
Rate for Payer: Cigna Commercial |
$260.62
|
Rate for Payer: First Health Commercial |
$298.30
|
Rate for Payer: Humana Commercial |
$266.90
|
Rate for Payer: Humana KY Medicaid |
$107.98
|
Rate for Payer: Humana Medicare Advantage |
$292.86
|
Rate for Payer: Kentucky WC Medicaid |
$109.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
Rate for Payer: Ohio Health Group HMO |
$235.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
Rate for Payer: PHCS Commercial |
$301.44
|
Rate for Payer: United Healthcare All Payer |
$276.32
|
|
CHEM INJ OMAYA RESERVOIR(T
|
Facility
|
IP
|
$314.00
|
|
Service Code
|
HCPCS 96542
|
Hospital Charge Code |
761T2498
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$40.82 |
Max. Negotiated Rate |
$301.44 |
Rate for Payer: Aetna Commercial |
$241.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
Rate for Payer: Cash Price |
$157.00
|
Rate for Payer: Cigna Commercial |
$260.62
|
Rate for Payer: First Health Commercial |
$298.30
|
Rate for Payer: Humana Commercial |
$266.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
Rate for Payer: Ohio Health Group HMO |
$235.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
Rate for Payer: PHCS Commercial |
$301.44
|
Rate for Payer: United Healthcare All Payer |
$276.32
|
|
CHEMODENER MUSCLE LARYNX EMG
|
Professional
|
Both
|
$1,275.00
|
|
Service Code
|
HCPCS 64617
|
Hospital Charge Code |
76102345
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$87.04 |
Max. Negotiated Rate |
$1,275.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.04
|
Rate for Payer: Anthem Medicaid |
$90.89
|
Rate for Payer: Buckeye Medicare Advantage |
$1,275.00
|
Rate for Payer: Cash Price |
$637.50
|
Rate for Payer: Cash Price |
$637.50
|
Rate for Payer: Cigna Commercial |
$319.45
|
Rate for Payer: Healthspan PPO |
$250.28
|
Rate for Payer: Humana Medicaid |
$90.89
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.71
|
Rate for Payer: Molina Healthcare Passport |
$90.89
|
Rate for Payer: Multiplan PHCS |
$765.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.50
|
Rate for Payer: UHCCP Medicaid |
$91.39
|
Rate for Payer: Wellcare CHIP/Medicaid |
$91.80
|
|
CHEMODENER MUSCLE LARYNX EM(P
|
Professional
|
Both
|
$375.00
|
|
Service Code
|
HCPCS 64617
|
Hospital Charge Code |
761P2345
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$87.04 |
Max. Negotiated Rate |
$375.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.04
|
Rate for Payer: Anthem Medicaid |
$90.89
|
Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
Rate for Payer: Cash Price |
$187.50
|
Rate for Payer: Cash Price |
$187.50
|
Rate for Payer: Cigna Commercial |
$319.45
|
Rate for Payer: Healthspan PPO |
$250.28
|
Rate for Payer: Humana Medicaid |
$90.89
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.71
|
Rate for Payer: Molina Healthcare Passport |
$90.89
|
Rate for Payer: Multiplan PHCS |
$225.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
Rate for Payer: UHCCP Medicaid |
$91.39
|
Rate for Payer: Wellcare CHIP/Medicaid |
$91.80
|
|
CHEMODENER MUSCLE LARYNX EM(T
|
Facility
|
OP
|
$900.00
|
|
Service Code
|
HCPCS 64617
|
Hospital Charge Code |
761T2345
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$117.00 |
Max. Negotiated Rate |
$864.00 |
Rate for Payer: Aetna Commercial |
$693.00
|
Rate for Payer: Anthem Medicaid |
$309.51
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
Rate for Payer: Cash Price |
$450.00
|
Rate for Payer: Cash Price |
$450.00
|
Rate for Payer: Cigna Commercial |
$747.00
|
Rate for Payer: First Health Commercial |
$855.00
|
Rate for Payer: Humana Commercial |
$765.00
|
Rate for Payer: Humana KY Medicaid |
$309.51
|
Rate for Payer: Humana Medicare Advantage |
$598.02
|
Rate for Payer: Kentucky WC Medicaid |
$312.66
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
Rate for Payer: Ohio Health Group HMO |
$675.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
Rate for Payer: PHCS Commercial |
$864.00
|
Rate for Payer: United Healthcare All Payer |
$792.00
|
|
CHEMODENER MUSCLE LARYNX EM(T
|
Facility
|
IP
|
$900.00
|
|
Service Code
|
HCPCS 64617
|
Hospital Charge Code |
761T2345
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$117.00 |
Max. Negotiated Rate |
$864.00 |
Rate for Payer: Aetna Commercial |
$693.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
Rate for Payer: Cash Price |
$450.00
|
Rate for Payer: Cigna Commercial |
$747.00
|
Rate for Payer: First Health Commercial |
$855.00
|
Rate for Payer: Humana Commercial |
$765.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
Rate for Payer: Ohio Health Group HMO |
$675.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
Rate for Payer: PHCS Commercial |
$864.00
|
Rate for Payer: United Healthcare All Payer |
$792.00
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Professional
|
Both
|
$692.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
76102352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$55.18 |
Max. Negotiated Rate |
$692.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
Rate for Payer: Anthem Medicaid |
$57.03
|
Rate for Payer: Buckeye Medicare Advantage |
$692.00
|
Rate for Payer: Cash Price |
$346.00
|
Rate for Payer: Cash Price |
$346.00
|
Rate for Payer: Cigna Commercial |
$155.22
|
Rate for Payer: Healthspan PPO |
$122.66
|
Rate for Payer: Humana Medicaid |
$57.03
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.76
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.17
|
Rate for Payer: Molina Healthcare Passport |
$57.03
|
Rate for Payer: Multiplan PHCS |
$415.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.40
|
Rate for Payer: UHCCP Medicaid |
$57.94
|
Rate for Payer: Wellcare CHIP/Medicaid |
$57.60
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
OP
|
$692.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
76102352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$89.96 |
Max. Negotiated Rate |
$664.32 |
Rate for Payer: Aetna Commercial |
$532.84
|
Rate for Payer: Anthem Medicaid |
$237.98
|
Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
Rate for Payer: Cash Price |
$346.00
|
Rate for Payer: Cigna Commercial |
$574.36
|
Rate for Payer: First Health Commercial |
$657.40
|
Rate for Payer: Humana Commercial |
$588.20
|
Rate for Payer: Humana KY Medicaid |
$237.98
|
Rate for Payer: Kentucky WC Medicaid |
$240.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$207.60
|
Rate for Payer: Molina Healthcare Medicaid |
$242.75
|
Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
Rate for Payer: Ohio Health Group HMO |
$519.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$89.96
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.52
|
Rate for Payer: PHCS Commercial |
$664.32
|
Rate for Payer: United Healthcare All Payer |
$608.96
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
IP
|
$692.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
76102352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$89.96 |
Max. Negotiated Rate |
$664.32 |
Rate for Payer: Aetna Commercial |
$532.84
|
Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
Rate for Payer: Cash Price |
$346.00
|
Rate for Payer: Cigna Commercial |
$574.36
|
Rate for Payer: First Health Commercial |
$657.40
|
Rate for Payer: Humana Commercial |
$588.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$207.60
|
Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
Rate for Payer: Ohio Health Group HMO |
$519.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$89.96
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.52
|
Rate for Payer: PHCS Commercial |
$664.32
|
Rate for Payer: United Healthcare All Payer |
$608.96
|
|
CHEMODENERV 1 EXTREM 1-4 EA(P
|
Professional
|
Both
|
$175.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
761P2352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$55.18 |
Max. Negotiated Rate |
$175.00 |
Rate for Payer: Wellcare CHIP/Medicaid |
$57.60
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
Rate for Payer: Anthem Medicaid |
$57.03
|
Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cigna Commercial |
$155.22
|
Rate for Payer: Healthspan PPO |
$122.66
|
Rate for Payer: Humana Medicaid |
$57.03
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.76
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.17
|
Rate for Payer: Molina Healthcare Passport |
$57.03
|
Rate for Payer: Multiplan PHCS |
$105.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
Rate for Payer: UHCCP Medicaid |
$57.94
|
|
CHEMODENERV 1 EXTREM 1-4 EA(T
|
Facility
|
IP
|
$517.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
761T2352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$67.21 |
Max. Negotiated Rate |
$496.32 |
Rate for Payer: Aetna Commercial |
$398.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
Rate for Payer: Cash Price |
$258.50
|
Rate for Payer: Cigna Commercial |
$429.11
|
Rate for Payer: First Health Commercial |
$491.15
|
Rate for Payer: Humana Commercial |
$439.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$155.10
|
Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
Rate for Payer: Ohio Health Group HMO |
$387.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$67.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.27
|
Rate for Payer: PHCS Commercial |
$496.32
|
Rate for Payer: United Healthcare All Payer |
$454.96
|
|
CHEMODENERV 1 EXTREM 1-4 EA(T
|
Facility
|
OP
|
$517.00
|
|
Service Code
|
HCPCS 64643
|
Hospital Charge Code |
761T2352
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$67.21 |
Max. Negotiated Rate |
$496.32 |
Rate for Payer: Aetna Commercial |
$398.09
|
Rate for Payer: Anthem Medicaid |
$177.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
Rate for Payer: Cash Price |
$258.50
|
Rate for Payer: Cigna Commercial |
$429.11
|
Rate for Payer: First Health Commercial |
$491.15
|
Rate for Payer: Humana Commercial |
$439.45
|
Rate for Payer: Humana KY Medicaid |
$177.80
|
Rate for Payer: Kentucky WC Medicaid |
$179.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$155.10
|
Rate for Payer: Molina Healthcare Medicaid |
$181.36
|
Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
Rate for Payer: Ohio Health Group HMO |
$387.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$67.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.27
|
Rate for Payer: PHCS Commercial |
$496.32
|
Rate for Payer: United Healthcare All Payer |
$454.96
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
OP
|
$746.00
|
|
Service Code
|
HCPCS 64645
|
Hospital Charge Code |
76102354
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$96.98 |
Max. Negotiated Rate |
$716.16 |
Rate for Payer: Aetna Commercial |
$574.42
|
Rate for Payer: Anthem Medicaid |
$256.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
Rate for Payer: Cash Price |
$373.00
|
Rate for Payer: Cigna Commercial |
$619.18
|
Rate for Payer: First Health Commercial |
$708.70
|
Rate for Payer: Humana Commercial |
$634.10
|
Rate for Payer: Humana KY Medicaid |
$256.55
|
Rate for Payer: Kentucky WC Medicaid |
$259.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
Rate for Payer: Ohio Health Group HMO |
$559.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$149.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$96.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.26
|
Rate for Payer: PHCS Commercial |
$716.16
|
Rate for Payer: United Healthcare All Payer |
$656.48
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
IP
|
$746.00
|
|
Service Code
|
HCPCS 64645
|
Hospital Charge Code |
76102354
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$96.98 |
Max. Negotiated Rate |
$716.16 |
Rate for Payer: Aetna Commercial |
$574.42
|
Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
Rate for Payer: Cash Price |
$373.00
|
Rate for Payer: Cigna Commercial |
$619.18
|
Rate for Payer: First Health Commercial |
$708.70
|
Rate for Payer: Humana Commercial |
$634.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
Rate for Payer: Ohio Health Group HMO |
$559.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$149.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$96.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.26
|
Rate for Payer: PHCS Commercial |
$716.16
|
Rate for Payer: United Healthcare All Payer |
$656.48
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Professional
|
Both
|
$746.00
|
|
Service Code
|
HCPCS 64645
|
Hospital Charge Code |
76102354
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$63.28 |
Max. Negotiated Rate |
$746.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.28
|
Rate for Payer: Anthem Medicaid |
$65.32
|
Rate for Payer: Buckeye Medicare Advantage |
$746.00
|
Rate for Payer: Cash Price |
$373.00
|
Rate for Payer: Cash Price |
$373.00
|
Rate for Payer: Cigna Commercial |
$189.42
|
Rate for Payer: Healthspan PPO |
$149.57
|
Rate for Payer: Humana Medicaid |
$65.32
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.37
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.63
|
Rate for Payer: Molina Healthcare Passport |
$65.32
|
Rate for Payer: Multiplan PHCS |
$447.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.20
|
Rate for Payer: UHCCP Medicaid |
$66.44
|
Rate for Payer: Wellcare CHIP/Medicaid |
$65.97
|
|