|
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 |
$41.39 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: Ambetter Exchange |
$59.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.50
|
| Rate for Payer: Anthem Medicaid |
$41.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.66
|
| 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 |
$41.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.22
|
| Rate for Payer: Molina Healthcare Passport |
$41.39
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.64
|
| Rate for Payer: UHCCP Medicaid |
$51.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.72
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
45000184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.40 |
| Max. Negotiated Rate |
$343.55 |
| Rate for Payer: Aetna Commercial |
$271.81
|
| Rate for Payer: Anthem Medicaid |
$121.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$292.99
|
| Rate for Payer: First Health Commercial |
$335.35
|
| Rate for Payer: Humana Commercial |
$300.05
|
| Rate for Payer: Humana KY Medicaid |
$121.40
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$122.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$289.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$260.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$310.64
|
| Rate for Payer: Ohio Health Group HMO |
$264.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.57
|
| Rate for Payer: PHCS Commercial |
$338.88
|
| Rate for Payer: United Healthcare All Payer |
$310.64
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761T1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
45000186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| 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 |
$145.79
|
| 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 |
$174.95
|
| 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 |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
76101049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| 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 |
$145.79
|
| 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 |
$174.95
|
| 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 |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APP CAST FINGEREG CONTRACTURE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
76101049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.60 |
| 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 |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| 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 |
$60.00 |
| 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 |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
APP CAST HAND LOWER FOREARM
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna Commercial |
$96.58
|
| Rate for Payer: Ambetter Exchange |
$64.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.43
|
| Rate for Payer: Anthem Medicaid |
$40.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.96
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$140.82
|
| Rate for Payer: Healthspan PPO |
$116.09
|
| Rate for Payer: Humana Medicaid |
$40.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.70
|
| Rate for Payer: Molina Healthcare Passport |
$40.88
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.37
|
| Rate for Payer: UHCCP Medicaid |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.13
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
45000185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
45000185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
APP CAST HAND LOWER FOREARM
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
76101048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
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 |
$40.88 |
| Max. Negotiated Rate |
$140.82 |
| Rate for Payer: Aetna Commercial |
$96.58
|
| Rate for Payer: Ambetter Exchange |
$64.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.43
|
| Rate for Payer: Anthem Medicaid |
$40.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.96
|
| 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 |
$40.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.70
|
| Rate for Payer: Molina Healthcare Passport |
$40.88
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.37
|
| Rate for Payer: UHCCP Medicaid |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.13
|
|
|
APP CAST HAND LOWER FOREARM(T
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
761T1048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
APP CAST HAND LOWER FOREARM(T
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
761T1048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Ambetter Exchange |
$64.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$50.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.32
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$143.95
|
| Rate for Payer: Healthspan PPO |
$117.70
|
| Rate for Payer: Humana Medicaid |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.15
|
| Rate for Payer: Molina Healthcare Passport |
$50.15
|
| Rate for Payer: Multiplan PHCS |
$390.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.76
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.43
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.88 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem Medicaid |
$223.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Humana KY Medicaid |
$223.88
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$226.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
761T1046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.28
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
45000183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
761T1046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.31 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Anthem Medicaid |
$129.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$293.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$312.08
|
| Rate for Payer: First Health Commercial |
$357.20
|
| Rate for Payer: Humana Commercial |
$319.60
|
| Rate for Payer: Humana KY Medicaid |
$129.31
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$130.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$308.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$277.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.88
|
| Rate for Payer: Ohio Health Group HMO |
$282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.44
|
| Rate for Payer: PHCS Commercial |
$360.96
|
| Rate for Payer: United Healthcare All Payer |
$330.88
|
|
|
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 |
$50.15 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Ambetter Exchange |
$64.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$50.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.32
|
| 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 |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.15
|
| Rate for Payer: Molina Healthcare Passport |
$50.15
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.76
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.43
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
45000183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
76101063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.60 |
| 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 |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
45000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
