|
APPLY RIGID LEG CAST
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
76101062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.20 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| 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: 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 |
$352.20
|
| 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
|
|
|
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
|
|
|
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 |
$300.00 |
| Rate for Payer: Aetna Commercial |
$170.68
|
| Rate for Payer: Ambetter Exchange |
$92.76
|
| 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 Individual/Medicaid |
$92.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$92.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.76
|
| 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 |
$120.59
|
| Rate for Payer: UHCCP Medicaid |
$84.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.76
|
|
|
APPLY RIGID LEG CAST(T
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
761T1062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.79 |
| Max. Negotiated Rate |
$647.04 |
| Rate for Payer: Aetna Commercial |
$518.98
|
| Rate for Payer: Anthem Medicaid |
$231.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$525.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$559.42
|
| Rate for Payer: First Health Commercial |
$640.30
|
| Rate for Payer: Humana Commercial |
$572.90
|
| Rate for Payer: Humana KY Medicaid |
$231.79
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$234.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$552.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$497.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$593.12
|
| Rate for Payer: Ohio Health Group HMO |
$505.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$539.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.06
|
| Rate for Payer: PHCS Commercial |
$647.04
|
| Rate for Payer: United Healthcare All Payer |
$593.12
|
|
|
APPLY RIGID LEG CAST(T
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 29445
|
| Hospital Charge Code |
761T1062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$647.04 |
| Rate for Payer: Aetna Commercial |
$518.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$525.72
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$559.42
|
| Rate for Payer: First Health Commercial |
$640.30
|
| Rate for Payer: Humana Commercial |
$572.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$552.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$497.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$593.12
|
| Rate for Payer: Ohio Health Group HMO |
$505.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$539.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.06
|
| Rate for Payer: PHCS Commercial |
$647.04
|
| Rate for Payer: United Healthcare All Payer |
$593.12
|
|
|
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 |
$547.01 |
| 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 |
$1,458.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.12
|
| 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: Ambetter Exchange |
$1,549.52
|
| Rate for Payer: Anthem Medicaid |
$1,510.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,549.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,549.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,859.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,549.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,549.52
|
| 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 |
$2,014.38
|
| Rate for Payer: UHCCP Medicaid |
$638.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,525.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,549.52
|
|
|
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 |
$547.01 |
| 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 |
$1,458.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.12
|
| Rate for Payer: PHCS Commercial |
$1,750.43
|
| Rate for Payer: United Healthcare All Payer |
$1,604.56
|
|
|
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: Ambetter Exchange |
$1,549.52
|
| Rate for Payer: Anthem Medicaid |
$1,510.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,549.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,549.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,859.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,549.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,549.52
|
| 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 |
$2,014.38
|
| Rate for Payer: UHCCP Medicaid |
$638.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,525.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,549.52
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$105.38
|
| Rate for Payer: Ambetter Exchange |
$51.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.18
|
| Rate for Payer: Anthem Medicaid |
$59.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.58
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$147.02
|
| Rate for Payer: Healthspan PPO |
$121.15
|
| Rate for Payer: Humana Medicaid |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.24
|
| Rate for Payer: Molina Healthcare Passport |
$59.06
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.72
|
| Rate for Payer: UHCCP Medicaid |
$47.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.32
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
76101061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
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 |
$240.00 |
| Rate for Payer: Aetna Commercial |
$105.38
|
| Rate for Payer: Ambetter Exchange |
$51.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.18
|
| Rate for Payer: Anthem Medicaid |
$59.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.58
|
| 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 |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.24
|
| Rate for Payer: Molina Healthcare Passport |
$59.06
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.72
|
| Rate for Payer: UHCCP Medicaid |
$47.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.32
|
|
|
APPLY SHORT LEG CAST(T
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
761T1061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
APPLY SHORT LEG CAST(T
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
761T1061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$147.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Facility
|
IP
|
$17,045.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
761T0352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,113.50 |
| Max. Negotiated Rate |
$16,363.20 |
| Rate for Payer: Aetna Commercial |
$13,124.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,295.10
|
| Rate for Payer: Cash Price |
$8,522.50
|
| Rate for Payer: Cigna Commercial |
$14,147.35
|
| Rate for Payer: First Health Commercial |
$16,192.75
|
| Rate for Payer: Humana Commercial |
$14,488.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,976.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,579.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,113.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,999.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,829.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,761.05
|
| Rate for Payer: PHCS Commercial |
$16,363.20
|
| Rate for Payer: United Healthcare All Payer |
$14,999.60
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Facility
|
OP
|
$18,370.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
76100352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,317.44 |
| Max. Negotiated Rate |
$17,635.20 |
| Rate for Payer: Aetna Commercial |
$14,144.90
|
| Rate for Payer: Anthem Medicaid |
$6,317.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,328.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$9,185.00
|
| Rate for Payer: Cash Price |
$9,185.00
|
| Rate for Payer: Cigna Commercial |
$15,247.10
|
| Rate for Payer: First Health Commercial |
$17,451.50
|
| Rate for Payer: Humana Commercial |
$15,614.50
|
| Rate for Payer: Humana KY Medicaid |
$6,317.44
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6,381.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,063.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,557.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,444.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,165.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,777.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,981.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,675.30
|
| Rate for Payer: PHCS Commercial |
$17,635.20
|
| Rate for Payer: United Healthcare All Payer |
$16,165.60
|
|
|
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 |
$11,022.00 |
| Rate for Payer: Aetna Commercial |
$1,460.89
|
| Rate for Payer: Ambetter Exchange |
$1,073.40
|
| Rate for Payer: Anthem Medicaid |
$357.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,073.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,073.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,288.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,073.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.40
|
| 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 |
$1,395.42
|
| Rate for Payer: UHCCP Medicaid |
$6,429.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,073.40
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Facility
|
OP
|
$17,045.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
761T0352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,861.78 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$13,124.65
|
| Rate for Payer: Anthem Medicaid |
$5,861.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,295.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$8,522.50
|
| Rate for Payer: Cash Price |
$8,522.50
|
| Rate for Payer: Cigna Commercial |
$14,147.35
|
| Rate for Payer: First Health Commercial |
$16,192.75
|
| Rate for Payer: Humana Commercial |
$14,488.25
|
| Rate for Payer: Humana KY Medicaid |
$5,861.78
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,921.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,976.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,579.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,979.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,999.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,829.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,761.05
|
| Rate for Payer: PHCS Commercial |
$16,363.20
|
| Rate for Payer: United Healthcare All Payer |
$14,999.60
|
|
|
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: Ambetter Exchange |
$1,073.40
|
| Rate for Payer: Anthem Medicaid |
$357.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,073.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,073.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,288.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,073.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.40
|
| 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 |
$1,395.42
|
| Rate for Payer: UHCCP Medicaid |
$463.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,073.40
|
|
|
APP MULTIPLANE (PINS OR WIRES)
|
Facility
|
IP
|
$18,370.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
76100352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,511.00 |
| Max. Negotiated Rate |
$17,635.20 |
| Rate for Payer: Aetna Commercial |
$14,144.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,328.60
|
| Rate for Payer: Cash Price |
$9,185.00
|
| Rate for Payer: Cigna Commercial |
$15,247.10
|
| Rate for Payer: First Health Commercial |
$17,451.50
|
| Rate for Payer: Humana Commercial |
$15,614.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,063.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,557.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,511.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,165.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,777.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,981.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,675.30
|
| Rate for Payer: PHCS Commercial |
$17,635.20
|
| Rate for Payer: United Healthcare All Payer |
$16,165.60
|
|
|
APPROACH CTO 18 WIRE
|
Facility
|
OP
|
$1,933.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.10 |
| Max. Negotiated Rate |
$1,856.30 |
| Rate for Payer: Aetna Commercial |
$1,488.91
|
| Rate for Payer: Anthem Medicaid |
$664.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.25
|
| Rate for Payer: Cash Price |
$966.82
|
| Rate for Payer: Cigna Commercial |
$1,604.93
|
| Rate for Payer: First Health Commercial |
$1,836.97
|
| Rate for Payer: Humana Commercial |
$1,643.60
|
| Rate for Payer: Humana KY Medicaid |
$664.98
|
| Rate for Payer: Kentucky WC Medicaid |
$671.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,682.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.22
|
| Rate for Payer: PHCS Commercial |
$1,856.30
|
| Rate for Payer: United Healthcare All Payer |
$1,701.61
|
|
|
APPROACH CTO 18 WIRE
|
Facility
|
IP
|
$1,933.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.10 |
| Max. Negotiated Rate |
$1,856.30 |
| Rate for Payer: Aetna Commercial |
$1,488.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.25
|
| Rate for Payer: Cash Price |
$966.82
|
| Rate for Payer: Cigna Commercial |
$1,604.93
|
| Rate for Payer: First Health Commercial |
$1,836.97
|
| Rate for Payer: Humana Commercial |
$1,643.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,682.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.22
|
| Rate for Payer: PHCS Commercial |
$1,856.30
|
| Rate for Payer: United Healthcare All Payer |
$1,701.61
|
|
|
APPROACH CTO 25 WIRE
|
Facility
|
OP
|
$1,943.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.95 |
| Max. Negotiated Rate |
$1,865.42 |
| Rate for Payer: Aetna Commercial |
$1,496.23
|
| Rate for Payer: Anthem Medicaid |
$668.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.66
|
| Rate for Payer: Cash Price |
$971.58
|
| Rate for Payer: Cigna Commercial |
$1,612.81
|
| Rate for Payer: First Health Commercial |
$1,845.99
|
| Rate for Payer: Humana Commercial |
$1,651.68
|
| Rate for Payer: Humana KY Medicaid |
$668.25
|
| Rate for Payer: Kentucky WC Medicaid |
$675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,593.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,434.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,457.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.77
|
| Rate for Payer: PHCS Commercial |
$1,865.42
|
| Rate for Payer: United Healthcare All Payer |
$1,709.97
|
|
|
APPROACH CTO 25 WIRE
|
Facility
|
IP
|
$1,943.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.95 |
| Max. Negotiated Rate |
$1,865.42 |
| Rate for Payer: Aetna Commercial |
$1,496.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.66
|
| Rate for Payer: Cash Price |
$971.58
|
| Rate for Payer: Cigna Commercial |
$1,612.81
|
| Rate for Payer: First Health Commercial |
$1,845.99
|
| Rate for Payer: Humana Commercial |
$1,651.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,593.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,434.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,457.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.77
|
| Rate for Payer: PHCS Commercial |
$1,865.42
|
| Rate for Payer: United Healthcare All Payer |
$1,709.97
|
|
