|
APPLICATION OF UNNABOOT(T
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
761T1070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
APPLICATION OF UNNABOOT(T
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
761T1070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$71.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$71.19
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$71.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
APP LONG ARM SPLTSHOULDERHAND
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
45000187
|
|
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 LONG ARM SPLTSHOULDERHAND
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
76101050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna Commercial |
$87.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.22
|
| Rate for Payer: Anthem Medicaid |
$34.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$584.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$134.54
|
| Rate for Payer: Healthspan PPO |
$107.53
|
| Rate for Payer: Humana Medicaid |
$34.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.86
|
| Rate for Payer: Molina Healthcare Passport |
$34.18
|
| Rate for Payer: Multiplan PHCS |
$350.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.80
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.52
|
|
|
APP LONG ARM SPLTSHOULDERHAND
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
76101050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem Medicaid |
$200.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Humana KY Medicaid |
$200.84
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$202.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
APP LONG ARM SPLTSHOULDERHAND
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
76101050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
APP LONG ARM SPLTSHOULDERHAND
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
45000187
|
|
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 LONG ARM SPLTSHOULDERHAN(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
761P1050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$87.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.22
|
| Rate for Payer: Anthem Medicaid |
$34.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$134.54
|
| Rate for Payer: Healthspan PPO |
$107.53
|
| Rate for Payer: Humana Medicaid |
$34.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.86
|
| Rate for Payer: Molina Healthcare Passport |
$34.18
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.52
|
|
|
APP LONG ARM SPLTSHOULDERHAN(T
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
761T1050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Humana KY Medicaid |
$140.66
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$142.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.79
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
APP LONG ARM SPLTSHOULDERHAN(T
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
761T1050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.79
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
761P1059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.21
|
| Rate for Payer: Anthem Medicaid |
$58.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$170.61
|
| Rate for Payer: Humana Medicaid |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.82
|
| Rate for Payer: Molina Healthcare Passport |
$58.65
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$53.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.24
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
761T1059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem Medicaid |
$166.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Humana KY Medicaid |
$166.45
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$168.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.67 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.29
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$959.00 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.21
|
| Rate for Payer: Anthem Medicaid |
$58.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$959.00
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$170.61
|
| Rate for Payer: Humana Medicaid |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.82
|
| Rate for Payer: Molina Healthcare Passport |
$58.65
|
| Rate for Payer: Multiplan PHCS |
$575.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$671.30
|
| Rate for Payer: UHCCP Medicaid |
$53.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.24
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
761T1059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
45000196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.67 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem Medicaid |
$329.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Humana KY Medicaid |
$329.80
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$333.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.29
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
45000196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$127.59
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$128.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
45000199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$104.50
|
| 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: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| 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 |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| 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 |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
45000199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| 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 |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
761P1064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.96
|
| Rate for Payer: Anthem Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$74.55
|
| Rate for Payer: Healthspan PPO |
$93.60
|
| Rate for Payer: Humana Medicaid |
$37.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.98
|
| Rate for Payer: Molina Healthcare Passport |
$37.24
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.61
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.96
|
| Rate for Payer: Anthem Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$74.55
|
| Rate for Payer: Healthspan PPO |
$93.60
|
| Rate for Payer: Humana Medicaid |
$37.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.98
|
| Rate for Payer: Molina Healthcare Passport |
$37.24
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.61
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
761T1064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Humana KY Medicaid |
$141.00
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$142.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
