|
APP CAST ELBOW TO FING LNG ARM
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
76101047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.50
|
| Rate for Payer: Anthem Medicaid |
$33.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,160.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Healthspan PPO |
$108.76
|
| Rate for Payer: Humana Medicaid |
$33.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.87
|
| Rate for Payer: Molina Healthcare Passport |
$33.21
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$812.00
|
| Rate for Payer: UHCCP Medicaid |
$51.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.54
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
76101047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$1,113.60 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem Medicaid |
$398.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Humana KY Medicaid |
$398.92
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$402.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.60
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761P1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.50
|
| Rate for Payer: Anthem Medicaid |
$33.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Healthspan PPO |
$108.76
|
| Rate for Payer: Humana Medicaid |
$33.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.87
|
| Rate for Payer: Molina Healthcare Passport |
$33.21
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.00
|
| Rate for Payer: UHCCP Medicaid |
$51.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.54
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761T1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
45000184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem Medicaid |
$117.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Humana KY Medicaid |
$117.96
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$119.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
45000184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761T1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
76101047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$1,113.60 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.60
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
76101049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
76101049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$190.76 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
45000186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
45000186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
45000185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$177.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$177.45
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$179.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
APP CAST HAND LOWER FOREARM
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$96.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.43
|
| Rate for Payer: Anthem Medicaid |
$34.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| Rate for Payer: Healthspan PPO |
$116.09
|
| Rate for Payer: Humana Medicaid |
$34.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.86
|
| Rate for Payer: Molina Healthcare Passport |
$34.18
|
| Rate for Payer: Multiplan PHCS |
$309.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$361.20
|
| Rate for Payer: UHCCP Medicaid |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.52
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
45000185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
APP CAST HAND LOWER FOREARM(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
761P1048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$96.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.43
|
| Rate for Payer: Anthem Medicaid |
$34.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| Rate for Payer: Healthspan PPO |
$116.09
|
| Rate for Payer: Humana Medicaid |
$34.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.86
|
| Rate for Payer: Molina Healthcare Passport |
$34.18
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.52
|
|
|
APP CAST HAND LOWER FOREARM(T
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
761T1048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
APP CAST HAND LOWER FOREARM(T
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
761T1048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
45000183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem Medicaid |
$216.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Humana KY Medicaid |
$216.31
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$218.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$220.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.99
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$603.84 |
| Rate for Payer: Aetna Commercial |
$484.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.62
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$522.07
|
| Rate for Payer: First Health Commercial |
$597.55
|
| Rate for Payer: Humana Commercial |
$534.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.52
|
| Rate for Payer: Ohio Health Group HMO |
$471.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.99
|
| Rate for Payer: PHCS Commercial |
$603.84
|
| Rate for Payer: United Healthcare All Payer |
$553.52
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
761P1046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$39.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$143.95
|
| Rate for Payer: Healthspan PPO |
$117.70
|
| Rate for Payer: Humana Medicaid |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.21
|
| Rate for Payer: Molina Healthcare Passport |
$39.42
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.81
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$39.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$629.00
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$143.95
|
| Rate for Payer: Healthspan PPO |
$117.70
|
| Rate for Payer: Humana Medicaid |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.21
|
| Rate for Payer: Molina Healthcare Passport |
$39.42
|
| Rate for Payer: Multiplan PHCS |
$377.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$440.30
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.81
|
|
