|
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
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.36
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$13.84
|
| Rate for Payer: Anthem Medicaid |
$24.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$556.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$152.34
|
| Rate for Payer: Healthspan PPO |
$93.96
|
| Rate for Payer: Humana Medicaid |
$24.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.77
|
| Rate for Payer: Molina Healthcare Passport |
$24.28
|
| Rate for Payer: Multiplan PHCS |
$333.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$389.20
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.52
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
76101071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem Medicaid |
$191.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Humana KY Medicaid |
$191.21
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$193.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.36
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
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 |
$220.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$13.84
|
| Rate for Payer: Anthem Medicaid |
$24.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$152.34
|
| Rate for Payer: Healthspan PPO |
$93.96
|
| Rate for Payer: Humana Medicaid |
$24.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.77
|
| Rate for Payer: Molina Healthcare Passport |
$24.28
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.52
|
|
|
APPLY MULTLAY COMPRS LWR LE(T
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
761T1071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem Medicaid |
$115.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Humana KY Medicaid |
$115.55
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$116.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.16
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
APPLY MULTLAY COMPRS LWR LE(T
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
761T1071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.16
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
76101062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$1,087.68 |
| Rate for Payer: Aetna Commercial |
$872.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$883.74
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$940.39
|
| Rate for Payer: First Health Commercial |
$1,076.35
|
| Rate for Payer: Humana Commercial |
$963.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.04
|
| Rate for Payer: Ohio Health Group HMO |
$849.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.23
|
| Rate for Payer: PHCS Commercial |
$1,087.68
|
| Rate for Payer: United Healthcare All Payer |
$997.04
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
76101062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$1,087.68 |
| Rate for Payer: Aetna Commercial |
$872.41
|
| Rate for Payer: Anthem Medicaid |
$389.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$883.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$940.39
|
| Rate for Payer: First Health Commercial |
$1,076.35
|
| Rate for Payer: Humana Commercial |
$963.05
|
| Rate for Payer: Humana KY Medicaid |
$389.64
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.04
|
| Rate for Payer: Ohio Health Group HMO |
$849.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.23
|
| Rate for Payer: PHCS Commercial |
$1,087.68
|
| Rate for Payer: United Healthcare All Payer |
$997.04
|
|
|
APPLY RIGID LEG CAST
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
76101062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: Aetna Commercial |
$170.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.32
|
| Rate for Payer: Anthem Medicaid |
$104.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,133.00
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$233.79
|
| Rate for Payer: Healthspan PPO |
$188.53
|
| Rate for Payer: Humana Medicaid |
$104.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.72
|
| Rate for Payer: Molina Healthcare Passport |
$104.63
|
| Rate for Payer: Multiplan PHCS |
$679.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.10
|
| Rate for Payer: UHCCP Medicaid |
$84.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.68
|
|
|
APPLY RIGID LEG CAST(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
761P1062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$170.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.32
|
| Rate for Payer: Anthem Medicaid |
$104.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$233.79
|
| Rate for Payer: Healthspan PPO |
$188.53
|
| Rate for Payer: Humana Medicaid |
$104.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.72
|
| Rate for Payer: Molina Healthcare Passport |
$104.63
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$84.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.68
|
|
|
APPLY RIGID LEG CAST(T
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
761T1062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
APPLY RIGID LEG CAST(T
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
761T1062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
APPLY R&L PULM ART BANDS
|
Facility
|
OP
|
$1,823.36
|
|
|
Service Code
|
HCPCS 33620
|
| Hospital Charge Code |
76101314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$1,750.43 |
| Rate for Payer: Aetna Commercial |
$1,403.99
|
| Rate for Payer: Anthem Medicaid |
$627.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.22
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cigna Commercial |
$1,513.39
|
| Rate for Payer: First Health Commercial |
$1,732.19
|
| Rate for Payer: Humana Commercial |
$1,549.86
|
| Rate for Payer: Humana KY Medicaid |
$627.05
|
| Rate for Payer: Kentucky WC Medicaid |
$633.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.24
|
| Rate for Payer: PHCS Commercial |
$1,750.43
|
| Rate for Payer: United Healthcare All Payer |
$1,604.56
|
|
|
APPLY R&L PULM ART BANDS
|
Facility
|
IP
|
$1,823.36
|
|
|
Service Code
|
HCPCS 33620
|
| Hospital Charge Code |
76101314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$1,750.43 |
| Rate for Payer: Aetna Commercial |
$1,403.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.22
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cigna Commercial |
$1,513.39
|
| Rate for Payer: First Health Commercial |
$1,732.19
|
| Rate for Payer: Humana Commercial |
$1,549.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.24
|
| Rate for Payer: PHCS Commercial |
$1,750.43
|
| Rate for Payer: United Healthcare All Payer |
$1,604.56
|
|
|
APPLY R&L PULM ART BANDS
|
Professional
|
Both
|
$1,823.36
|
|
|
Service Code
|
HCPCS 33620
|
| Hospital Charge Code |
76101314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$638.18 |
| Max. Negotiated Rate |
$3,190.41 |
| Rate for Payer: Aetna Commercial |
$3,060.86
|
| Rate for Payer: Anthem Medicaid |
$1,510.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,823.36
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cigna Commercial |
$3,190.41
|
| Rate for Payer: Healthspan PPO |
$2,256.38
|
| Rate for Payer: Humana Medicaid |
$1,510.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,334.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,540.40
|
| Rate for Payer: Molina Healthcare Passport |
$1,510.20
|
| Rate for Payer: Multiplan PHCS |
$1,094.02
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,276.35
|
| Rate for Payer: UHCCP Medicaid |
$638.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,525.30
|
|
|
APPLY R&L PULM ART BANDS(P
|
Professional
|
Both
|
$1,823.36
|
|
|
Service Code
|
HCPCS 33620
|
| Hospital Charge Code |
761P1314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$638.18 |
| Max. Negotiated Rate |
$3,190.41 |
| Rate for Payer: Aetna Commercial |
$3,060.86
|
| Rate for Payer: Anthem Medicaid |
$1,510.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,823.36
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cash Price |
$911.68
|
| Rate for Payer: Cigna Commercial |
$3,190.41
|
| Rate for Payer: Healthspan PPO |
$2,256.38
|
| Rate for Payer: Humana Medicaid |
$1,510.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,334.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,540.40
|
| Rate for Payer: Molina Healthcare Passport |
$1,510.20
|
| Rate for Payer: Multiplan PHCS |
$1,094.02
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,276.35
|
| Rate for Payer: UHCCP Medicaid |
$638.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,525.30
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.43 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.41
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.43 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem Medicaid |
$278.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Humana KY Medicaid |
$278.90
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$281.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.41
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$811.00 |
| Rate for Payer: Aetna Commercial |
$105.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.18
|
| Rate for Payer: Anthem Medicaid |
$46.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$811.00
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$147.02
|
| Rate for Payer: Healthspan PPO |
$121.15
|
| Rate for Payer: Humana Medicaid |
$46.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.97
|
| Rate for Payer: Molina Healthcare Passport |
$46.05
|
| Rate for Payer: Multiplan PHCS |
$486.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$567.70
|
| Rate for Payer: UHCCP Medicaid |
$47.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.51
|
|
|
APPLY SHORT LEG CAST(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
761P1061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$105.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.18
|
| Rate for Payer: Anthem Medicaid |
$46.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$147.02
|
| Rate for Payer: Healthspan PPO |
$121.15
|
| Rate for Payer: Humana Medicaid |
$46.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.97
|
| Rate for Payer: Molina Healthcare Passport |
$46.05
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$47.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.51
|
|
|
APPLY SHORT LEG CAST(T
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
761T1061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
APPLY SHORT LEG CAST(T
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
761T1061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem Medicaid |
$141.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Humana KY Medicaid |
$141.34
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$142.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Professional
|
Both
|
$18,370.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
76100352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.51 |
| Max. Negotiated Rate |
$18,370.00 |
| Rate for Payer: Aetna Commercial |
$1,460.89
|
| Rate for Payer: Anthem Medicaid |
$357.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$18,370.00
|
| Rate for Payer: Cash Price |
$9,185.00
|
| Rate for Payer: Cash Price |
$9,185.00
|
| Rate for Payer: Cigna Commercial |
$679.22
|
| Rate for Payer: Healthspan PPO |
$1,323.26
|
| Rate for Payer: Humana Medicaid |
$357.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,344.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.66
|
| Rate for Payer: Molina Healthcare Passport |
$357.51
|
| Rate for Payer: Multiplan PHCS |
$11,022.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12,859.00
|
| Rate for Payer: UHCCP Medicaid |
$6,429.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.09
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
761P0352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.51 |
| Max. Negotiated Rate |
$1,460.89 |
| Rate for Payer: Aetna Commercial |
$1,460.89
|
| Rate for Payer: Anthem Medicaid |
$357.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,325.00
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$679.22
|
| Rate for Payer: Healthspan PPO |
$1,323.26
|
| Rate for Payer: Humana Medicaid |
$357.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,344.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.66
|
| Rate for Payer: Molina Healthcare Passport |
$357.51
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.50
|
| Rate for Payer: UHCCP Medicaid |
$463.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.09
|
|
