|
CHEMODENER MUSCLE LARYNX EMG
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
76102345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.04 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Ambetter Exchange |
$102.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$146.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.17
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$319.45
|
| Rate for Payer: Healthspan PPO |
$250.28
|
| Rate for Payer: Humana Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.19
|
| Rate for Payer: Molina Healthcare Passport |
$146.26
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.43
|
| Rate for Payer: UHCCP Medicaid |
$91.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.64
|
|
|
CHEMODENER MUSCLE LARYNX EMG
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
76102345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| 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: 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 |
$382.50
|
| 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
|
|
|
CHEMODENER MUSCLE LARYNX EM(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
761P2345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.04 |
| Max. Negotiated Rate |
$319.45 |
| Rate for Payer: Ambetter Exchange |
$102.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$146.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.17
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$319.45
|
| Rate for Payer: Healthspan PPO |
$250.28
|
| Rate for Payer: Humana Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.19
|
| Rate for Payer: Molina Healthcare Passport |
$146.26
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.43
|
| Rate for Payer: UHCCP Medicaid |
$91.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.64
|
|
|
CHEMODENER MUSCLE LARYNX EM(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
761T2345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CHEMODENER MUSCLE LARYNX EM(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 64617
|
| Hospital Charge Code |
761T2345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
76102352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Ambetter Exchange |
$65.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$71.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.85
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$155.22
|
| Rate for Payer: Healthspan PPO |
$122.66
|
| Rate for Payer: Humana Medicaid |
$71.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.69
|
| Rate for Payer: Molina Healthcare Passport |
$71.26
|
| Rate for Payer: Multiplan PHCS |
$435.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.42
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.71
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
76102352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.94
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
76102352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem Medicaid |
$249.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Humana KY Medicaid |
$249.67
|
| Rate for Payer: Kentucky WC Medicaid |
$252.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.94
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
761P2352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$155.22 |
| Rate for Payer: Ambetter Exchange |
$65.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$71.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.85
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$155.22
|
| Rate for Payer: Healthspan PPO |
$122.66
|
| Rate for Payer: Humana Medicaid |
$71.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.69
|
| Rate for Payer: Molina Healthcare Passport |
$71.26
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.42
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.71
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA(T
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
761T2352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$528.96 |
| Rate for Payer: Aetna Commercial |
$424.27
|
| Rate for Payer: Anthem Medicaid |
$189.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.78
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$457.33
|
| Rate for Payer: First Health Commercial |
$523.45
|
| Rate for Payer: Humana Commercial |
$468.35
|
| Rate for Payer: Humana KY Medicaid |
$189.49
|
| Rate for Payer: Kentucky WC Medicaid |
$191.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.88
|
| Rate for Payer: Ohio Health Group HMO |
$413.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.19
|
| Rate for Payer: PHCS Commercial |
$528.96
|
| Rate for Payer: United Healthcare All Payer |
$484.88
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA(T
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
761T2352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$528.96 |
| Rate for Payer: Aetna Commercial |
$424.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.78
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$457.33
|
| Rate for Payer: First Health Commercial |
$523.45
|
| Rate for Payer: Humana Commercial |
$468.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.88
|
| Rate for Payer: Ohio Health Group HMO |
$413.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.19
|
| Rate for Payer: PHCS Commercial |
$528.96
|
| Rate for Payer: United Healthcare All Payer |
$484.88
|
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
76102354
|
|
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 Medicaid |
$268.24
|
| 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: Humana KY Medicaid |
$268.24
|
| 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 |
$234.00
|
| 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
|
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
76102354
|
|
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
|
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
76102354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Ambetter Exchange |
$77.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.28
|
| Rate for Payer: Anthem Medicaid |
$86.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.64
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$189.42
|
| Rate for Payer: Healthspan PPO |
$149.57
|
| Rate for Payer: Humana Medicaid |
$86.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.54
|
| Rate for Payer: Molina Healthcare Passport |
$86.80
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.36
|
| Rate for Payer: UHCCP Medicaid |
$66.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.20
|
|
|
CHEMODENERV 1 EXTREM 5/> EA(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
761P2354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$189.42 |
| Rate for Payer: Ambetter Exchange |
$77.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.28
|
| Rate for Payer: Anthem Medicaid |
$86.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.64
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$189.42
|
| Rate for Payer: Healthspan PPO |
$149.57
|
| Rate for Payer: Humana Medicaid |
$86.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.54
|
| Rate for Payer: Molina Healthcare Passport |
$86.80
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.36
|
| Rate for Payer: UHCCP Medicaid |
$66.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.20
|
|
|
CHEMODENERV 1 EXTREM 5/> EA(T
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
761T2354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$427.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.90
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$460.65
|
| Rate for Payer: First Health Commercial |
$527.25
|
| Rate for Payer: Humana Commercial |
$471.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.40
|
| Rate for Payer: Ohio Health Group HMO |
$416.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.95
|
| Rate for Payer: PHCS Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Payer |
$488.40
|
|
|
CHEMODENERV 1 EXTREM 5/> EA(T
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS 64645
|
| Hospital Charge Code |
761T2354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$427.35
|
| Rate for Payer: Anthem Medicaid |
$190.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.90
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$460.65
|
| Rate for Payer: First Health Commercial |
$527.25
|
| Rate for Payer: Humana Commercial |
$471.75
|
| Rate for Payer: Humana KY Medicaid |
$190.86
|
| Rate for Payer: Kentucky WC Medicaid |
$192.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.40
|
| Rate for Payer: Ohio Health Group HMO |
$416.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.95
|
| Rate for Payer: PHCS Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Payer |
$488.40
|
|
|
CHEMODENERV 1 EXTREM 5/> MU(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
761P2353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$267.96 |
| Rate for Payer: Ambetter Exchange |
$109.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.88
|
| Rate for Payer: Anthem Medicaid |
$122.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.94
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$267.96
|
| Rate for Payer: Healthspan PPO |
$211.18
|
| Rate for Payer: Humana Medicaid |
$122.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.09
|
| Rate for Payer: Molina Healthcare Passport |
$122.64
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$142.94
|
| Rate for Payer: UHCCP Medicaid |
$98.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.95
|
|
|
CHEMODENERV 1 EXTREM 5/> MUS
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
76102353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.60 |
| Max. Negotiated Rate |
$1,266.24 |
| Rate for Payer: Aetna Commercial |
$1,015.63
|
| Rate for Payer: Anthem Medicaid |
$453.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,028.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$659.50
|
| Rate for Payer: Cash Price |
$659.50
|
| Rate for Payer: Cigna Commercial |
$1,094.77
|
| Rate for Payer: First Health Commercial |
$1,253.05
|
| Rate for Payer: Humana Commercial |
$1,121.15
|
| Rate for Payer: Humana KY Medicaid |
$453.60
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$458.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,081.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$973.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$462.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,160.72
|
| Rate for Payer: Ohio Health Group HMO |
$989.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$910.11
|
| Rate for Payer: PHCS Commercial |
$1,266.24
|
| Rate for Payer: United Healthcare All Payer |
$1,160.72
|
|
|
CHEMODENERV 1 EXTREM 5/> MUS
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
76102353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.70 |
| Max. Negotiated Rate |
$1,266.24 |
| Rate for Payer: Aetna Commercial |
$1,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,028.82
|
| Rate for Payer: Cash Price |
$659.50
|
| Rate for Payer: Cigna Commercial |
$1,094.77
|
| Rate for Payer: First Health Commercial |
$1,253.05
|
| Rate for Payer: Humana Commercial |
$1,121.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,081.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$973.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,160.72
|
| Rate for Payer: Ohio Health Group HMO |
$989.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$910.11
|
| Rate for Payer: PHCS Commercial |
$1,266.24
|
| Rate for Payer: United Healthcare All Payer |
$1,160.72
|
|
|
CHEMODENERV 1 EXTREM 5/> MUS
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
76102353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$791.40 |
| Rate for Payer: Ambetter Exchange |
$109.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.88
|
| Rate for Payer: Anthem Medicaid |
$122.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.94
|
| Rate for Payer: Cash Price |
$659.50
|
| Rate for Payer: Cash Price |
$659.50
|
| Rate for Payer: Cigna Commercial |
$267.96
|
| Rate for Payer: Healthspan PPO |
$211.18
|
| Rate for Payer: Humana Medicaid |
$122.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.09
|
| Rate for Payer: Molina Healthcare Passport |
$122.64
|
| Rate for Payer: Multiplan PHCS |
$791.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$142.94
|
| Rate for Payer: UHCCP Medicaid |
$98.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.95
|
|
|
CHEMODENERV 1 EXTREM 5/> MU(T
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
761T2353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.84 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem Medicaid |
$341.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Humana KY Medicaid |
$341.84
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$345.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
CHEMODENERV 1 EXTREM 5/> MU(T
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
HCPCS 64644
|
| Hospital Charge Code |
761T2353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
CHEMODENERV 1 EXTREMITY 1-4
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
76102351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.41 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem Medicaid |
$436.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,053.27
|
| Rate for Payer: First Health Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial |
$1,078.65
|
| Rate for Payer: Humana KY Medicaid |
$436.41
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$440.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,040.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$936.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,116.72
|
| Rate for Payer: Ohio Health Group HMO |
$951.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.61
|
| Rate for Payer: PHCS Commercial |
$1,218.24
|
| Rate for Payer: United Healthcare All Payer |
$1,116.72
|
|
|
CHEMODENERV 1 EXTREMITY 1-4
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
76102351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.02 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Ambetter Exchange |
$101.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.02
|
| Rate for Payer: Anthem Medicaid |
$107.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.76
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$234.95
|
| Rate for Payer: Healthspan PPO |
$185.37
|
| Rate for Payer: Humana Medicaid |
$107.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.71
|
| Rate for Payer: Molina Healthcare Passport |
$107.56
|
| Rate for Payer: Multiplan PHCS |
$761.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.91
|
| Rate for Payer: UHCCP Medicaid |
$90.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.47
|
|
