|
CHEMODENERV ECCRINE GLANDS(T
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
761T2357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Humana KY Medicaid |
$173.33
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$175.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.24
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761T2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem Medicaid |
$171.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Humana KY Medicaid |
$171.26
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$173.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.38
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761P2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$210.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.43
|
| Rate for Payer: Anthem Medicaid |
$79.62
|
| 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 |
$246.78
|
| Rate for Payer: Healthspan PPO |
$185.60
|
| Rate for Payer: Humana Medicaid |
$79.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.21
|
| Rate for Payer: Molina Healthcare Passport |
$79.62
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$87.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.42
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761T2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.44
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.38
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem Medicaid |
$308.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Humana KY Medicaid |
$308.82
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$311.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$898.00 |
| Rate for Payer: Aetna Commercial |
$210.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.43
|
| Rate for Payer: Anthem Medicaid |
$79.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$898.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$246.78
|
| Rate for Payer: Healthspan PPO |
$185.60
|
| Rate for Payer: Humana Medicaid |
$79.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.21
|
| Rate for Payer: Molina Healthcare Passport |
$79.62
|
| Rate for Payer: Multiplan PHCS |
$538.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$628.60
|
| Rate for Payer: UHCCP Medicaid |
$87.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.42
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.28 |
| Max. Negotiated Rate |
$1,205.76 |
| Rate for Payer: Aetna Commercial |
$967.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$979.68
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna Commercial |
$1,042.48
|
| Rate for Payer: First Health Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial |
$1,067.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,105.28
|
| Rate for Payer: Ohio Health Group HMO |
$942.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.36
|
| Rate for Payer: PHCS Commercial |
$1,205.76
|
| Rate for Payer: United Healthcare All Payer |
$1,105.28
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$101.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,256.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna Commercial |
$252.38
|
| Rate for Payer: Healthspan PPO |
$143.11
|
| Rate for Payer: Humana Medicaid |
$101.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.87
|
| Rate for Payer: Molina Healthcare Passport |
$101.83
|
| Rate for Payer: Multiplan PHCS |
$753.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$879.20
|
| Rate for Payer: UHCCP Medicaid |
$91.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.85
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.28 |
| Max. Negotiated Rate |
$1,205.76 |
| Rate for Payer: Aetna Commercial |
$967.12
|
| Rate for Payer: Anthem Medicaid |
$431.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$979.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cigna Commercial |
$1,042.48
|
| Rate for Payer: First Health Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial |
$1,067.60
|
| Rate for Payer: Humana KY Medicaid |
$431.94
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$436.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$440.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,105.28
|
| Rate for Payer: Ohio Health Group HMO |
$942.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.36
|
| Rate for Payer: PHCS Commercial |
$1,205.76
|
| Rate for Payer: United Healthcare All Payer |
$1,105.28
|
|
|
CHEMODENERV MUSC MIGRAINE(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761P2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$101.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$252.38
|
| Rate for Payer: Healthspan PPO |
$143.11
|
| Rate for Payer: Humana Medicaid |
$101.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.87
|
| Rate for Payer: Molina Healthcare Passport |
$101.83
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$91.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.85
|
|
|
CHEMODENERV MUSC MIGRAINE(T
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761T2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.36
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
CHEMODENERV MUSC MIGRAINE(T
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761T2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem Medicaid |
$191.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Humana KY Medicaid |
$191.21
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$193.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.36
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$850.56 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.66
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.68
|
| Rate for Payer: Anthem Medicaid |
$83.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$886.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$207.56
|
| Rate for Payer: Healthspan PPO |
$165.06
|
| Rate for Payer: Humana Medicaid |
$83.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.67
|
| Rate for Payer: Molina Healthcare Passport |
$83.99
|
| Rate for Payer: Multiplan PHCS |
$531.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.20
|
| Rate for Payer: UHCCP Medicaid |
$91.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.83
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$850.56 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem Medicaid |
$304.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Humana KY Medicaid |
$304.70
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$307.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.66
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
CHEMODENERV MUSC NECK DYSTO(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761P2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.68
|
| Rate for Payer: Anthem Medicaid |
$83.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.56
|
| Rate for Payer: Healthspan PPO |
$165.06
|
| Rate for Payer: Humana Medicaid |
$83.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.67
|
| Rate for Payer: Molina Healthcare Passport |
$83.99
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$91.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.83
|
|
|
CHEMODENERV MUSC NECK DYSTO(T
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761T2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
CHEMODENERV MUSC NECK DYSTO(T
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761T2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$218.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$218.72
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$220.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$992.35
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.01 |
| Max. Negotiated Rate |
$952.66 |
| Rate for Payer: Aetna Commercial |
$764.11
|
| Rate for Payer: Anthem Medicaid |
$341.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$496.18
|
| Rate for Payer: Cash Price |
$496.18
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$942.73
|
| Rate for Payer: Humana Commercial |
$843.50
|
| Rate for Payer: Humana KY Medicaid |
$341.27
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$344.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.27
|
| Rate for Payer: Ohio Health Group HMO |
$744.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.63
|
| Rate for Payer: PHCS Commercial |
$952.66
|
| Rate for Payer: United Healthcare All Payer |
$873.27
|
|
|
CHEMODENERV SALIV GLANDS
|
Professional
|
Both
|
$992.35
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$992.35 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.93
|
| Rate for Payer: Anthem Medicaid |
$79.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$992.35
|
| Rate for Payer: Cash Price |
$496.18
|
| Rate for Payer: Cash Price |
$496.18
|
| Rate for Payer: Cigna Commercial |
$174.39
|
| Rate for Payer: Healthspan PPO |
$101.94
|
| Rate for Payer: Humana Medicaid |
$79.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.80
|
| Rate for Payer: Molina Healthcare Passport |
$79.22
|
| Rate for Payer: Multiplan PHCS |
$595.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$694.64
|
| Rate for Payer: UHCCP Medicaid |
$59.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.01
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$992.35
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.01 |
| Max. Negotiated Rate |
$952.66 |
| Rate for Payer: Aetna Commercial |
$764.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.03
|
| Rate for Payer: Cash Price |
$496.18
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$942.73
|
| Rate for Payer: Humana Commercial |
$843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.27
|
| Rate for Payer: Ohio Health Group HMO |
$744.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.63
|
| Rate for Payer: PHCS Commercial |
$952.66
|
| Rate for Payer: United Healthcare All Payer |
$873.27
|
|
|
CHEMODENERV SALIV GLANDS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761P2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.93
|
| Rate for Payer: Anthem Medicaid |
$79.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$174.39
|
| Rate for Payer: Healthspan PPO |
$101.94
|
| Rate for Payer: Humana Medicaid |
$79.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.80
|
| Rate for Payer: Molina Healthcare Passport |
$79.22
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$59.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.01
|
|
|
CHEMODENERV SALIV GLANDS(T
|
Facility
|
OP
|
$542.35
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761T2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.51 |
| Max. Negotiated Rate |
$520.66 |
| Rate for Payer: Aetna Commercial |
$417.61
|
| Rate for Payer: Anthem Medicaid |
$186.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$271.18
|
| Rate for Payer: Cash Price |
$271.18
|
| Rate for Payer: Cigna Commercial |
$450.15
|
| Rate for Payer: First Health Commercial |
$515.23
|
| Rate for Payer: Humana Commercial |
$461.00
|
| Rate for Payer: Humana KY Medicaid |
$186.51
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$188.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.27
|
| Rate for Payer: Ohio Health Group HMO |
$406.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.13
|
| Rate for Payer: PHCS Commercial |
$520.66
|
| Rate for Payer: United Healthcare All Payer |
$477.27
|
|
|
CHEMODENERV SALIV GLANDS(T
|
Facility
|
IP
|
$542.35
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761T2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.51 |
| Max. Negotiated Rate |
$520.66 |
| Rate for Payer: Aetna Commercial |
$417.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.03
|
| Rate for Payer: Cash Price |
$271.18
|
| Rate for Payer: Cigna Commercial |
$450.15
|
| Rate for Payer: First Health Commercial |
$515.23
|
| Rate for Payer: Humana Commercial |
$461.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.27
|
| Rate for Payer: Ohio Health Group HMO |
$406.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.13
|
| Rate for Payer: PHCS Commercial |
$520.66
|
| Rate for Payer: United Healthcare All Payer |
$477.27
|
|
