|
CHEMODENERV 1 EXTREMITY 1-4
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
76102351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.70 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| 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: 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 |
$380.70
|
| 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(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
761P2351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.02 |
| Max. Negotiated Rate |
$234.95 |
| 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 |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| 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 |
$165.00
|
| 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
|
|
|
CHEMODENERV 1 EXTREMITY 1-4(T
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
761T2351
|
|
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 EXTREMITY 1-4(T
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
761T2351
|
|
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
|
|
|
CHEMODENERVATION ANAL MUSC
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 46505
|
| Hospital Charge Code |
76102902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.90 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
CHEMODENERVATION ANAL MUSC
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 46505
|
| Hospital Charge Code |
76102902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
CHEMODENERVATION ANAL MUSC
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 46505
|
| Hospital Charge Code |
76102902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.31 |
| Max. Negotiated Rate |
$457.80 |
| Rate for Payer: Aetna Commercial |
$310.03
|
| Rate for Payer: Ambetter Exchange |
$233.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.38
|
| Rate for Payer: Anthem Medicaid |
$166.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$233.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$233.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$280.16
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$345.38
|
| Rate for Payer: Healthspan PPO |
$306.58
|
| Rate for Payer: Humana Medicaid |
$166.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$295.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$233.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.64
|
| Rate for Payer: Molina Healthcare Passport |
$166.31
|
| Rate for Payer: Multiplan PHCS |
$457.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$303.51
|
| Rate for Payer: UHCCP Medicaid |
$174.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.47
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
76102357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$407.40 |
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Ambetter Exchange |
$38.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$44.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.13
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$91.26
|
| Rate for Payer: Healthspan PPO |
$80.55
|
| Rate for Payer: Humana Medicaid |
$44.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Molina Healthcare Passport |
$44.52
|
| Rate for Payer: Multiplan PHCS |
$407.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.97
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.44
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Professional
|
Both
|
$307.50
|
|
|
Service Code
|
HCPCS 64653
|
| Hospital Charge Code |
76102670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna Commercial |
$80.11
|
| Rate for Payer: Ambetter Exchange |
$48.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.32
|
| Rate for Payer: Anthem Medicaid |
$51.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.30
|
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Cigna Commercial |
$105.19
|
| Rate for Payer: Healthspan PPO |
$94.14
|
| Rate for Payer: Humana Medicaid |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.69
|
| Rate for Payer: Molina Healthcare Passport |
$51.66
|
| Rate for Payer: Multiplan PHCS |
$184.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.15
|
| Rate for Payer: UHCCP Medicaid |
$37.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.58
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
76102357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: Aetna Commercial |
$522.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$529.62
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$563.57
|
| Rate for Payer: First Health Commercial |
$645.05
|
| Rate for Payer: Humana Commercial |
$577.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$556.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$597.52
|
| Rate for Payer: Ohio Health Group HMO |
$509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$543.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.51
|
| Rate for Payer: PHCS Commercial |
$651.84
|
| Rate for Payer: United Healthcare All Payer |
$597.52
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
76102357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.51 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: Aetna Commercial |
$522.83
|
| Rate for Payer: Anthem Medicaid |
$233.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$529.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$563.57
|
| Rate for Payer: First Health Commercial |
$645.05
|
| Rate for Payer: Humana Commercial |
$577.15
|
| Rate for Payer: Humana KY Medicaid |
$233.51
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$235.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$556.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$597.52
|
| Rate for Payer: Ohio Health Group HMO |
$509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$543.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.51
|
| Rate for Payer: PHCS Commercial |
$651.84
|
| Rate for Payer: United Healthcare All Payer |
$597.52
|
|
|
CHEMODENERV ECCRINE GLANDS(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
761P2357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: Ambetter Exchange |
$38.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.90
|
| Rate for Payer: Anthem Medicaid |
$44.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.13
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$91.26
|
| Rate for Payer: Healthspan PPO |
$80.55
|
| Rate for Payer: Humana Medicaid |
$44.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Molina Healthcare Passport |
$44.52
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.97
|
| Rate for Payer: UHCCP Medicaid |
$30.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.44
|
|
|
CHEMODENERV ECCRINE GLANDS(T
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
761T2357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
CHEMODENERV ECCRINE GLANDS(T
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
HCPCS 64650
|
| Hospital Charge Code |
761T2357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Humana KY Medicaid |
$173.33
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$175.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$210.55
|
| Rate for Payer: Ambetter Exchange |
$111.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.43
|
| Rate for Payer: Anthem Medicaid |
$99.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.55
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$246.78
|
| Rate for Payer: Healthspan PPO |
$185.60
|
| Rate for Payer: Humana Medicaid |
$99.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.05
|
| Rate for Payer: Molina Healthcare Passport |
$99.07
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.68
|
| Rate for Payer: UHCCP Medicaid |
$87.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.29
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761T2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.11 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem Medicaid |
$177.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Humana KY Medicaid |
$177.11
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$178.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761T2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
761P2342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$246.78 |
| Rate for Payer: Aetna Commercial |
$210.55
|
| Rate for Payer: Ambetter Exchange |
$111.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.43
|
| Rate for Payer: Anthem Medicaid |
$99.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.55
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$246.78
|
| Rate for Payer: Healthspan PPO |
$185.60
|
| Rate for Payer: Humana Medicaid |
$99.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.05
|
| Rate for Payer: Molina Healthcare Passport |
$99.07
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.68
|
| Rate for Payer: UHCCP Medicaid |
$87.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.29
|
|
|
CHEMODENERV MUSC FASCIAL BOTOX
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
76102342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$1,240.32 |
| Rate for Payer: Aetna Commercial |
$994.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,007.76
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: First Health Commercial |
$1,227.40
|
| Rate for Payer: Humana Commercial |
$1,098.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.96
|
| Rate for Payer: Ohio Health Group HMO |
$969.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.48
|
| Rate for Payer: PHCS Commercial |
$1,240.32
|
| Rate for Payer: United Healthcare All Payer |
$1,136.96
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$1,240.32 |
| Rate for Payer: Aetna Commercial |
$994.84
|
| Rate for Payer: Anthem Medicaid |
$444.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,007.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: First Health Commercial |
$1,227.40
|
| Rate for Payer: Humana Commercial |
$1,098.20
|
| Rate for Payer: Humana KY Medicaid |
$444.32
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$448.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.96
|
| Rate for Payer: Ohio Health Group HMO |
$969.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.48
|
| Rate for Payer: PHCS Commercial |
$1,240.32
|
| Rate for Payer: United Healthcare All Payer |
$1,136.96
|
|
|
CHEMODENERV MUSC MIGRAINE
|
Professional
|
Both
|
$1,292.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
76102343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Ambetter Exchange |
$117.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$112.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.57
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$252.38
|
| Rate for Payer: Healthspan PPO |
$143.11
|
| Rate for Payer: Humana Medicaid |
$112.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.93
|
| Rate for Payer: Molina Healthcare Passport |
$112.68
|
| Rate for Payer: Multiplan PHCS |
$775.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.28
|
| Rate for Payer: UHCCP Medicaid |
$91.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.14
|
|
|
CHEMODENERV MUSC MIGRAINE(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761P2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.75 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Ambetter Exchange |
$117.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$112.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.57
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$252.38
|
| Rate for Payer: Healthspan PPO |
$143.11
|
| Rate for Payer: Humana Medicaid |
$112.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.93
|
| Rate for Payer: Molina Healthcare Passport |
$112.68
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.28
|
| Rate for Payer: UHCCP Medicaid |
$91.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.14
|
|
