|
Chemical peel, nonfacial; derm
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
761T2722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
Chemical peel, nonfacial; derm
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
761P2722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$550.25 |
| Rate for Payer: Aetna Commercial |
$489.90
|
| Rate for Payer: Ambetter Exchange |
$334.57
|
| Rate for Payer: Anthem Medicaid |
$117.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$334.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$334.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$401.48
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$550.25
|
| Rate for Payer: Healthspan PPO |
$511.54
|
| Rate for Payer: Humana Medicaid |
$117.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$334.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.97
|
| Rate for Payer: Molina Healthcare Passport |
$117.62
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.94
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$334.57
|
|
|
Chemical peel, nonfacial; derm
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
76102722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem Medicaid |
$495.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Humana KY Medicaid |
$495.22
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$500.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
Chemical peel, nonfacial; derm
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
76102722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
Chemical peel, nonfacial; derm
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
76102722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$489.90
|
| Rate for Payer: Ambetter Exchange |
$334.57
|
| Rate for Payer: Anthem Medicaid |
$117.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$334.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$334.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$401.48
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$550.25
|
| Rate for Payer: Healthspan PPO |
$511.54
|
| Rate for Payer: Humana Medicaid |
$117.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$334.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.97
|
| Rate for Payer: Molina Healthcare Passport |
$117.62
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.94
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$334.57
|
|
|
Chemical peel, nonfacial; derm
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 15793
|
| Hospital Charge Code |
761T2722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
Chemical peel, nonfacial; epid
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
76102721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
Chemical peel, nonfacial; epid
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
76102721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
Chemical peel, nonfacial; epid
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
761T2721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
Chemical peel, nonfacial; epid
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
761T2721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
Chemical peel, nonfacial; epid
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
761P2721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$493.61 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Ambetter Exchange |
$194.82
|
| Rate for Payer: Anthem Medicaid |
$65.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.78
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$493.61
|
| Rate for Payer: Healthspan PPO |
$447.18
|
| Rate for Payer: Humana Medicaid |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.70
|
| Rate for Payer: Molina Healthcare Passport |
$65.39
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$253.27
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.82
|
|
|
Chemical peel, nonfacial; epid
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 15792
|
| Hospital Charge Code |
76102721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Ambetter Exchange |
$194.82
|
| Rate for Payer: Anthem Medicaid |
$65.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$194.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.78
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$493.61
|
| Rate for Payer: Healthspan PPO |
$447.18
|
| Rate for Payer: Humana Medicaid |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$194.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.70
|
| Rate for Payer: Molina Healthcare Passport |
$65.39
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$253.27
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$194.82
|
|
|
CHEMICAL PLEURODESIS
|
Facility
|
OP
|
$2,824.00
|
|
|
Service Code
|
HCPCS 32560
|
| Hospital Charge Code |
76101204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,202.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$2,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,456.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,948.56
|
| Rate for Payer: PHCS Commercial |
$2,711.04
|
| Rate for Payer: United Healthcare All Payer |
$2,485.12
|
|
|
CHEMICAL PLEURODESIS
|
Facility
|
IP
|
$2,824.00
|
|
|
Service Code
|
HCPCS 32560
|
| Hospital Charge Code |
76101204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$847.20 |
| 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 |
$2,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,456.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,948.56
|
| 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 |
$1,694.40 |
| Rate for Payer: Aetna Commercial |
$191.82
|
| Rate for Payer: Ambetter Exchange |
$71.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.11
|
| Rate for Payer: Anthem Medicaid |
$221.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.62
|
| 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 |
$221.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.37
|
| Rate for Payer: Molina Healthcare Passport |
$221.93
|
| Rate for Payer: Multiplan PHCS |
$1,694.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.75
|
| Rate for Payer: UHCCP Medicaid |
$41.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.35
|
|
|
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 |
$450.00 |
| Rate for Payer: Aetna Commercial |
$191.82
|
| Rate for Payer: Ambetter Exchange |
$71.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.11
|
| Rate for Payer: Anthem Medicaid |
$221.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.62
|
| 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 |
$221.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.37
|
| Rate for Payer: Molina Healthcare Passport |
$221.93
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.75
|
| Rate for Payer: UHCCP Medicaid |
$41.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.35
|
|
|
CHEMICAL PLEURODESIS(T
|
Facility
|
IP
|
$2,074.00
|
|
|
Service Code
|
HCPCS 32560
|
| Hospital Charge Code |
761T1204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.20 |
| 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 |
$1,659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,804.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.06
|
| Rate for Payer: PHCS Commercial |
$1,991.04
|
| Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
|
CHEMICAL PLEURODESIS(T
|
Facility
|
OP
|
$2,074.00
|
|
|
Service Code
|
HCPCS 32560
|
| Hospital Charge Code |
761T1204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,617.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$1,659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,804.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.06
|
| Rate for Payer: PHCS Commercial |
$1,991.04
|
| Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
|
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 |
$428.40 |
| Rate for Payer: Aetna Commercial |
$71.83
|
| Rate for Payer: Ambetter Exchange |
$38.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.46
|
| Rate for Payer: Anthem Medicaid |
$154.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.32
|
| 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 |
$154.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.54
|
| Rate for Payer: Molina Healthcare Passport |
$154.45
|
| Rate for Payer: Multiplan PHCS |
$428.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.18
|
| Rate for Payer: UHCCP Medicaid |
$22.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$155.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.60
|
|
|
CHEM INJ OMAYA RESERVOIR
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
76102498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.20 |
| 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 |
$571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.66
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
CHEM INJ OMAYA RESERVOIR
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
76102498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.54 |
| 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 |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.66
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
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 |
$274.96 |
| Rate for Payer: Aetna Commercial |
$71.83
|
| Rate for Payer: Ambetter Exchange |
$38.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.46
|
| Rate for Payer: Anthem Medicaid |
$154.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.32
|
| 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 |
$154.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.54
|
| Rate for Payer: Molina Healthcare Passport |
$154.45
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.18
|
| Rate for Payer: UHCCP Medicaid |
$22.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$155.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.60
|
|
|
CHEM INJ OMAYA RESERVOIR(T
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
761T2498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.98 |
| Max. Negotiated Rate |
$429.06 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| 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 |
$94.20 |
| 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 |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
CHEMODENER MUSCLE LARYNX EMG
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
76102345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.47 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
