|
APP LONG ARM SPLTSHOULDERHAN(T
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
761T1050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem Medicaid |
$149.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Humana KY Medicaid |
$149.60
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$151.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$152.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
APP LONG ARM SPLTSHOULDERHAN(T
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
761T1050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.30
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$594.60 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Ambetter Exchange |
$94.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.21
|
| Rate for Payer: Anthem Medicaid |
$72.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$112.91
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$170.61
|
| Rate for Payer: Humana Medicaid |
$72.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.78
|
| Rate for Payer: Molina Healthcare Passport |
$72.33
|
| Rate for Payer: Multiplan PHCS |
$594.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.32
|
| Rate for Payer: UHCCP Medicaid |
$53.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.09
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.30 |
| Max. Negotiated Rate |
$951.36 |
| Rate for Payer: Aetna Commercial |
$763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.98
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$822.53
|
| Rate for Payer: First Health Commercial |
$941.45
|
| Rate for Payer: Humana Commercial |
$842.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$731.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.08
|
| Rate for Payer: Ohio Health Group HMO |
$743.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.79
|
| Rate for Payer: PHCS Commercial |
$951.36
|
| Rate for Payer: United Healthcare All Payer |
$872.08
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
761T1059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.45 |
| 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 |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| 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 |
$245.39
|
| 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 |
$294.47
|
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
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 |
$285.00 |
| Rate for Payer: Aetna Commercial |
$150.89
|
| Rate for Payer: Ambetter Exchange |
$94.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.21
|
| Rate for Payer: Anthem Medicaid |
$72.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$112.91
|
| 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 |
$72.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.78
|
| Rate for Payer: Molina Healthcare Passport |
$72.33
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.32
|
| Rate for Payer: UHCCP Medicaid |
$53.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.09
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
76101059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$951.36 |
| Rate for Payer: Aetna Commercial |
$763.07
|
| Rate for Payer: Anthem Medicaid |
$340.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$822.53
|
| Rate for Payer: First Health Commercial |
$941.45
|
| Rate for Payer: Humana Commercial |
$842.35
|
| Rate for Payer: Humana KY Medicaid |
$340.80
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$344.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$731.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.08
|
| Rate for Payer: Ohio Health Group HMO |
$743.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.79
|
| Rate for Payer: PHCS Commercial |
$951.36
|
| Rate for Payer: United Healthcare All Payer |
$872.08
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
761T1059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.80 |
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
45000196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.45 |
| 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 |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| 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 |
$245.39
|
| 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 |
$294.47
|
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
APP LONG LEG CASTTHIGH TO TOES
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
45000196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.80 |
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Ambetter Exchange |
$49.94
|
| 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 Individual/Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.93
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$49.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.98
|
| Rate for Payer: Molina Healthcare Passport |
$37.24
|
| Rate for Payer: Multiplan PHCS |
$411.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.92
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.94
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
45000199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$73.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$73.94
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$74.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
761T1064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$418.56 |
| Rate for Payer: Aetna Commercial |
$335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.08
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$361.88
|
| Rate for Payer: First Health Commercial |
$414.20
|
| Rate for Payer: Humana Commercial |
$370.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$383.68
|
| Rate for Payer: Ohio Health Group HMO |
$327.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.84
|
| Rate for Payer: PHCS Commercial |
$418.56
|
| Rate for Payer: United Healthcare All Payer |
$383.68
|
|
|
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 |
$150.00 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Ambetter Exchange |
$49.94
|
| 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 Individual/Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.93
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$49.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| 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 |
$64.92
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.94
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
761T1064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$418.56 |
| Rate for Payer: Aetna Commercial |
$335.72
|
| Rate for Payer: Anthem Medicaid |
$149.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$361.88
|
| Rate for Payer: First Health Commercial |
$414.20
|
| Rate for Payer: Humana Commercial |
$370.60
|
| Rate for Payer: Humana KY Medicaid |
$149.94
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$151.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$152.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$383.68
|
| Rate for Payer: Ohio Health Group HMO |
$327.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.84
|
| Rate for Payer: PHCS Commercial |
$418.56
|
| Rate for Payer: United Healthcare All Payer |
$383.68
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.34
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
45000199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
APP LONGLEGSPLNTTHIGH>ANKORTOE
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
76101064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem Medicaid |
$235.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Humana KY Medicaid |
$235.92
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$238.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.34
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Ambetter Exchange |
$25.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$13.84
|
| Rate for Payer: Anthem Medicaid |
$62.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.06
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$152.34
|
| Rate for Payer: Healthspan PPO |
$93.96
|
| Rate for Payer: Humana Medicaid |
$62.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.07
|
| Rate for Payer: Molina Healthcare Passport |
$62.81
|
| Rate for Payer: Multiplan PHCS |
$346.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.56
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.05
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem Medicaid |
$198.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Humana KY Medicaid |
$198.77
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$200.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
APPLY MULTLAY COMPRS LWR LE(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
761P1071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Ambetter Exchange |
$25.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$13.84
|
| Rate for Payer: Anthem Medicaid |
$62.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.06
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$152.34
|
| Rate for Payer: Healthspan PPO |
$93.96
|
| Rate for Payer: Humana Medicaid |
$62.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.07
|
| Rate for Payer: Molina Healthcare Passport |
$62.81
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.56
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.05
|
|
|
APPLY MULTLAY COMPRS LWR LE(T
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
761T1071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.12 |
| Max. Negotiated Rate |
$343.68 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem Medicaid |
$123.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Humana KY Medicaid |
$123.12
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$124.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
|
APPLY MULTLAY COMPRS LWR LE(T
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
761T1071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$343.68 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$279.24
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$297.14
|
| Rate for Payer: First Health Commercial |
$340.10
|
| Rate for Payer: Humana Commercial |
$304.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$293.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.04
|
| Rate for Payer: Ohio Health Group HMO |
$268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.02
|
| Rate for Payer: PHCS Commercial |
$343.68
|
| Rate for Payer: United Healthcare All Payer |
$315.04
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
76101062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.06
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
