|
CHEMODENERV MUSC MIGRAINE(T
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761T2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.59 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem Medicaid |
$203.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Humana KY Medicaid |
$203.59
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$205.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
CHEMODENERV MUSC MIGRAINE(T
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
761T2343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.68 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Ambetter Exchange |
$104.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.68
|
| Rate for Payer: Anthem Medicaid |
$94.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$207.56
|
| Rate for Payer: Healthspan PPO |
$165.06
|
| Rate for Payer: Humana Medicaid |
$94.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.49
|
| Rate for Payer: Molina Healthcare Passport |
$94.60
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.95
|
| Rate for Payer: UHCCP Medicaid |
$91.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.58
|
|
|
CHEMODENERV MUSC NECK DYSTON
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
76102344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
CHEMODENERV MUSC NECK DYSTO(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761P2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.68 |
| Max. Negotiated Rate |
$207.56 |
| Rate for Payer: Ambetter Exchange |
$104.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$86.68
|
| Rate for Payer: Anthem Medicaid |
$94.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.50
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.56
|
| Rate for Payer: Healthspan PPO |
$165.06
|
| Rate for Payer: Humana Medicaid |
$94.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.49
|
| Rate for Payer: Molina Healthcare Passport |
$94.60
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.95
|
| Rate for Payer: UHCCP Medicaid |
$91.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.58
|
|
|
CHEMODENERV MUSC NECK DYSTO(T
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761T2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.10 |
| Max. Negotiated Rate |
$649.92 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$528.06
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$561.91
|
| Rate for Payer: First Health Commercial |
$643.15
|
| Rate for Payer: Humana Commercial |
$575.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$555.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$499.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$595.76
|
| Rate for Payer: Ohio Health Group HMO |
$507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$467.13
|
| Rate for Payer: PHCS Commercial |
$649.92
|
| Rate for Payer: United Healthcare All Payer |
$595.76
|
|
|
CHEMODENERV MUSC NECK DYSTO(T
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
761T2344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.82 |
| Max. Negotiated Rate |
$649.92 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Anthem Medicaid |
$232.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$528.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cash Price |
$338.50
|
| Rate for Payer: Cigna Commercial |
$561.91
|
| Rate for Payer: First Health Commercial |
$643.15
|
| Rate for Payer: Humana Commercial |
$575.45
|
| Rate for Payer: Humana KY Medicaid |
$232.82
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$235.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$555.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$499.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$237.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$595.76
|
| Rate for Payer: Ohio Health Group HMO |
$507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$467.13
|
| Rate for Payer: PHCS Commercial |
$649.92
|
| Rate for Payer: United Healthcare All Payer |
$595.76
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$953.28 |
| Rate for Payer: Aetna Commercial |
$764.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.54
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$824.19
|
| Rate for Payer: First Health Commercial |
$943.35
|
| Rate for Payer: Humana Commercial |
$844.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$814.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.84
|
| Rate for Payer: Ohio Health Group HMO |
$744.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.17
|
| Rate for Payer: PHCS Commercial |
$953.28
|
| Rate for Payer: United Healthcare All Payer |
$873.84
|
|
|
CHEMODENERV SALIV GLANDS
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Ambetter Exchange |
$105.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.93
|
| Rate for Payer: Anthem Medicaid |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.70
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$174.39
|
| Rate for Payer: Healthspan PPO |
$101.94
|
| Rate for Payer: Humana Medicaid |
$87.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.28
|
| Rate for Payer: Molina Healthcare Passport |
$87.53
|
| Rate for Payer: Multiplan PHCS |
$595.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.25
|
| Rate for Payer: UHCCP Medicaid |
$59.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.58
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
76102341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$953.28 |
| Rate for Payer: Aetna Commercial |
$764.61
|
| Rate for Payer: Anthem Medicaid |
$341.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$824.19
|
| Rate for Payer: First Health Commercial |
$943.35
|
| Rate for Payer: Humana Commercial |
$844.05
|
| Rate for Payer: Humana KY Medicaid |
$341.49
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$344.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$814.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.84
|
| Rate for Payer: Ohio Health Group HMO |
$744.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.17
|
| Rate for Payer: PHCS Commercial |
$953.28
|
| Rate for Payer: United Healthcare All Payer |
$873.84
|
|
|
CHEMODENERV SALIV GLANDS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761P2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Ambetter Exchange |
$105.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.93
|
| Rate for Payer: Anthem Medicaid |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.70
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$174.39
|
| Rate for Payer: Healthspan PPO |
$101.94
|
| Rate for Payer: Humana Medicaid |
$87.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.28
|
| Rate for Payer: Molina Healthcare Passport |
$87.53
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.25
|
| Rate for Payer: UHCCP Medicaid |
$59.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.58
|
|
|
CHEMODENERV SALIV GLANDS(T
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761T2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.74 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CHEMODENERV SALIV GLANDS(T
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 64611
|
| Hospital Charge Code |
761T2341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CHEMODENERV TRUNK MUSC 1-5
|
Professional
|
Both
|
$1,292.33
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
76102355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$775.40 |
| Rate for Payer: Ambetter Exchange |
$110.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.61
|
| Rate for Payer: Anthem Medicaid |
$115.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.06
|
| Rate for Payer: Cash Price |
$646.16
|
| Rate for Payer: Cash Price |
$646.16
|
| Rate for Payer: Cigna Commercial |
$252.89
|
| Rate for Payer: Healthspan PPO |
$199.50
|
| Rate for Payer: Humana Medicaid |
$115.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$148.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.15
|
| Rate for Payer: Molina Healthcare Passport |
$115.83
|
| Rate for Payer: Multiplan PHCS |
$775.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.14
|
| Rate for Payer: UHCCP Medicaid |
$93.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.88
|
|
|
CHEMODENERV TRUNK MUSC 1-5
|
Facility
|
OP
|
$1,292.33
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
76102355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.43 |
| Max. Negotiated Rate |
$1,240.64 |
| Rate for Payer: Aetna Commercial |
$995.09
|
| Rate for Payer: Anthem Medicaid |
$444.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$646.16
|
| Rate for Payer: Cash Price |
$646.16
|
| Rate for Payer: Cigna Commercial |
$1,072.63
|
| Rate for Payer: First Health Commercial |
$1,227.71
|
| Rate for Payer: Humana Commercial |
$1,098.48
|
| Rate for Payer: Humana KY Medicaid |
$444.43
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$448.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.25
|
| Rate for Payer: Ohio Health Group HMO |
$969.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.71
|
| Rate for Payer: PHCS Commercial |
$1,240.64
|
| Rate for Payer: United Healthcare All Payer |
$1,137.25
|
|
|
CHEMODENERV TRUNK MUSC 1-5
|
Facility
|
IP
|
$1,292.33
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
76102355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.70 |
| Max. Negotiated Rate |
$1,240.64 |
| Rate for Payer: Aetna Commercial |
$995.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.02
|
| Rate for Payer: Cash Price |
$646.16
|
| Rate for Payer: Cigna Commercial |
$1,072.63
|
| Rate for Payer: First Health Commercial |
$1,227.71
|
| Rate for Payer: Humana Commercial |
$1,098.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.25
|
| Rate for Payer: Ohio Health Group HMO |
$969.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.71
|
| Rate for Payer: PHCS Commercial |
$1,240.64
|
| Rate for Payer: United Healthcare All Payer |
$1,137.25
|
|
|
CHEMODENERV TRUNK MUSC 1-5(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
761P2355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Ambetter Exchange |
$110.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.61
|
| Rate for Payer: Anthem Medicaid |
$115.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.06
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$252.89
|
| Rate for Payer: Healthspan PPO |
$199.50
|
| Rate for Payer: Humana Medicaid |
$115.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$148.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.15
|
| Rate for Payer: Molina Healthcare Passport |
$115.83
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.14
|
| Rate for Payer: UHCCP Medicaid |
$93.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.88
|
|
|
CHEMODENERV TRUNK MUSC 1-5(T
|
Facility
|
OP
|
$992.33
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
761T2355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.26 |
| Max. Negotiated Rate |
$952.64 |
| Rate for Payer: Aetna Commercial |
$764.09
|
| Rate for Payer: Anthem Medicaid |
$341.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$496.16
|
| Rate for Payer: Cash Price |
$496.16
|
| Rate for Payer: Cigna Commercial |
$823.63
|
| Rate for Payer: First Health Commercial |
$942.71
|
| Rate for Payer: Humana Commercial |
$843.48
|
| Rate for Payer: Humana KY Medicaid |
$341.26
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$344.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.25
|
| Rate for Payer: Ohio Health Group HMO |
$744.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.71
|
| Rate for Payer: PHCS Commercial |
$952.64
|
| Rate for Payer: United Healthcare All Payer |
$873.25
|
|
|
CHEMODENERV TRUNK MUSC 1-5(T
|
Facility
|
IP
|
$992.33
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
761T2355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.70 |
| Max. Negotiated Rate |
$952.64 |
| Rate for Payer: Aetna Commercial |
$764.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$774.02
|
| Rate for Payer: Cash Price |
$496.16
|
| Rate for Payer: Cigna Commercial |
$823.63
|
| Rate for Payer: First Health Commercial |
$942.71
|
| Rate for Payer: Humana Commercial |
$843.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$873.25
|
| Rate for Payer: Ohio Health Group HMO |
$744.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.71
|
| Rate for Payer: PHCS Commercial |
$952.64
|
| Rate for Payer: United Healthcare All Payer |
$873.25
|
|
|
CHEMODENERV TRUNK MUSC 6/>
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
76102356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.32 |
| Max. Negotiated Rate |
$1,421.76 |
| Rate for Payer: Aetna Commercial |
$1,140.37
|
| Rate for Payer: Anthem Medicaid |
$509.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,155.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$740.50
|
| Rate for Payer: Cash Price |
$740.50
|
| Rate for Payer: Cigna Commercial |
$1,229.23
|
| Rate for Payer: First Health Commercial |
$1,406.95
|
| Rate for Payer: Humana Commercial |
$1,258.85
|
| Rate for Payer: Humana KY Medicaid |
$509.32
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$514.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,214.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,092.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$519.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,110.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,288.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.89
|
| Rate for Payer: PHCS Commercial |
$1,421.76
|
| Rate for Payer: United Healthcare All Payer |
$1,303.28
|
|
|
CHEMODENERV TRUNK MUSC 6/>
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
76102356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$888.60 |
| Rate for Payer: Ambetter Exchange |
$125.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.45
|
| Rate for Payer: Anthem Medicaid |
$134.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.98
|
| Rate for Payer: Cash Price |
$740.50
|
| Rate for Payer: Cash Price |
$740.50
|
| Rate for Payer: Cigna Commercial |
$292.87
|
| Rate for Payer: Healthspan PPO |
$231.04
|
| Rate for Payer: Humana Medicaid |
$134.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.88
|
| Rate for Payer: Molina Healthcare Passport |
$134.20
|
| Rate for Payer: Multiplan PHCS |
$888.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.57
|
| Rate for Payer: UHCCP Medicaid |
$112.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.82
|
|
|
CHEMODENERV TRUNK MUSC 6/>
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
76102356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.30 |
| Max. Negotiated Rate |
$1,421.76 |
| Rate for Payer: Aetna Commercial |
$1,140.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,155.18
|
| Rate for Payer: Cash Price |
$740.50
|
| Rate for Payer: Cigna Commercial |
$1,229.23
|
| Rate for Payer: First Health Commercial |
$1,406.95
|
| Rate for Payer: Humana Commercial |
$1,258.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,214.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,092.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,110.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,288.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.89
|
| Rate for Payer: PHCS Commercial |
$1,421.76
|
| Rate for Payer: United Healthcare All Payer |
$1,303.28
|
|
|
CHEMODENERV TRUNK MUSC 6/>(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
761P2356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$292.87 |
| Rate for Payer: Ambetter Exchange |
$125.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.45
|
| Rate for Payer: Anthem Medicaid |
$134.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.98
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$292.87
|
| Rate for Payer: Healthspan PPO |
$231.04
|
| Rate for Payer: Humana Medicaid |
$134.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.88
|
| Rate for Payer: Molina Healthcare Passport |
$134.20
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.57
|
| Rate for Payer: UHCCP Medicaid |
$112.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.82
|
|
|
CHEMODENERV TRUNK MUSC 6/>(T
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
761T2356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.39
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
