|
Cheeks Laser Hair Removal
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200216
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Cheeks LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200217
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
Cheeks LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200474
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
CHEM CAUT GRANULATION TISS
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Ambetter Exchange |
$35.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.41
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.01
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$98.89
|
| Rate for Payer: Healthspan PPO |
$81.27
|
| Rate for Payer: Humana Medicaid |
$24.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.26
|
| Rate for Payer: Molina Healthcare Passport |
$24.76
|
| Rate for Payer: Multiplan PHCS |
$262.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.51
|
| Rate for Payer: UHCCP Medicaid |
$21.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.01
|
|
|
CHEM CAUT GRANULATION TISS
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
CHEM CAUT GRANULATION TISS
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
CHEM CAUT GRANULATION TISS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
45000082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
CHEM CAUT GRANULATION TISS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
45000082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
CHEM CAUT GRANULATION TISS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
761P0253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$98.89 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Ambetter Exchange |
$35.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.41
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.01
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$98.89
|
| Rate for Payer: Healthspan PPO |
$81.27
|
| Rate for Payer: Humana Medicaid |
$24.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.26
|
| Rate for Payer: Molina Healthcare Passport |
$24.76
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.51
|
| Rate for Payer: UHCCP Medicaid |
$21.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.01
|
|
|
CHEM CAUT GRANULATION TISS(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
761T0253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
CHEM CAUT GRANULATION TISS(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
761T0253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
CHEMICAL PEEL - BACK
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200326
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
CHEMICAL PEEL - FACE
|
Professional
|
Both
|
$125.00
|
|
| Hospital Charge Code |
22200325
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$87.50 |
| 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 |
$573.60 |
| 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 |
$1,529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.28
|
| 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 |
$565.60 |
| 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 |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| 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 |
$565.60
|
| 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 |
$678.72
|
| 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 |
$1,529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.28
|
| 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 |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$590.48
|
| Rate for Payer: Ambetter Exchange |
$385.06
|
| Rate for Payer: Anthem Medicaid |
$180.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$385.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$385.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$462.07
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.06
|
| 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 |
$500.58
|
| Rate for Payer: UHCCP Medicaid |
$669.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$385.06
|
|
|
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 |
$734.39 |
| Rate for Payer: Aetna Commercial |
$590.48
|
| Rate for Payer: Ambetter Exchange |
$385.06
|
| Rate for Payer: Anthem Medicaid |
$180.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$385.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$385.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$462.07
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.06
|
| 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 |
$500.58
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$385.06
|
|
|
CHEMICAL PEEL FACIAL DERMAL(T
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 15789
|
| Hospital Charge Code |
761T0212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem Medicaid |
$244.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| 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 |
$565.60
|
| 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 |
$678.72
|
| 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 |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
CHEMICAL PEEL FACIAL DERMAL(T
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS 15789
|
| Hospital Charge Code |
761T0212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.60 |
| 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 |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$324.37
|
| Rate for Payer: Ambetter Exchange |
$201.12
|
| Rate for Payer: Anthem Medicaid |
$100.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$201.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.12
|
| 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 |
$261.46
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.12
|
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
IP
|
$770.63
|
|
|
Service Code
|
HCPCS 15788
|
| Hospital Charge Code |
761T0211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.19 |
| 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 |
$616.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.73
|
| Rate for Payer: PHCS Commercial |
$739.80
|
| Rate for Payer: United Healthcare All Payer |
$678.15
|
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
IP
|
$1,770.63
|
|
|
Service Code
|
HCPCS 15788
|
| Hospital Charge Code |
76100211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$531.19 |
| 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 |
$1,416.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.73
|
| Rate for Payer: PHCS Commercial |
$1,699.80
|
| Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
|
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 |
$1,062.38 |
| Rate for Payer: Aetna Commercial |
$324.37
|
| Rate for Payer: Ambetter Exchange |
$201.12
|
| Rate for Payer: Anthem Medicaid |
$100.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$201.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.12
|
| 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 |
$261.46
|
| Rate for Payer: UHCCP Medicaid |
$619.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.12
|
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
OP
|
$1,770.63
|
|
|
Service Code
|
HCPCS 15788
|
| Hospital Charge Code |
76100211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$1,416.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.73
|
| Rate for Payer: PHCS Commercial |
$1,699.80
|
| Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
|
CHEMICAL PEEL FACIAL EPIDERMAL
|
Facility
|
OP
|
$770.63
|
|
|
Service Code
|
HCPCS 15788
|
| Hospital Charge Code |
761T0211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.02 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$616.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.73
|
| Rate for Payer: PHCS Commercial |
$739.80
|
| Rate for Payer: United Healthcare All Payer |
$678.15
|
|
