|
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 |
$2,388.10 |
| 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 |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,328.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| 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 |
$11,381.14
|
| 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 |
$13,657.37
|
| 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 |
$3,674.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,388.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,694.70
|
| 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 |
$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)
|
Facility
|
OP
|
$17,045.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
761T0352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,215.85 |
| Max. Negotiated Rate |
$16,363.20 |
| Rate for Payer: Aetna Commercial |
$13,124.65
|
| Rate for Payer: Anthem Medicaid |
$5,861.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,295.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| 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 |
$11,381.14
|
| 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 |
$13,657.37
|
| 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 |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,215.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.95
|
| 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: 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
|
|
|
APPROACH CTO 18 WIRE
|
Facility
|
IP
|
$1,933.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$1,856.28 |
| Rate for Payer: Aetna Commercial |
$1,488.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.22
|
| Rate for Payer: Cash Price |
$966.81
|
| Rate for Payer: Cigna Commercial |
$1,604.90
|
| Rate for Payer: First Health Commercial |
$1,836.94
|
| Rate for Payer: Humana Commercial |
$1,643.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.42
|
| Rate for Payer: PHCS Commercial |
$1,856.28
|
| Rate for Payer: United Healthcare All Payer |
$1,701.59
|
|
|
APPROACH CTO 18 WIRE
|
Facility
|
OP
|
$1,933.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$1,856.28 |
| Rate for Payer: Aetna Commercial |
$1,488.89
|
| Rate for Payer: Anthem Medicaid |
$664.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.22
|
| Rate for Payer: Cash Price |
$966.81
|
| Rate for Payer: Cigna Commercial |
$1,604.90
|
| Rate for Payer: First Health Commercial |
$1,836.94
|
| Rate for Payer: Humana Commercial |
$1,643.58
|
| Rate for Payer: Humana KY Medicaid |
$664.97
|
| Rate for Payer: Kentucky WC Medicaid |
$671.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.42
|
| Rate for Payer: PHCS Commercial |
$1,856.28
|
| Rate for Payer: United Healthcare All Payer |
$1,701.59
|
|
|
APPROACH CTO 25 WIRE
|
Facility
|
IP
|
$1,942.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.51 |
| Max. Negotiated Rate |
$1,864.68 |
| Rate for Payer: Aetna Commercial |
$1,495.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.06
|
| Rate for Payer: Cash Price |
$971.19
|
| Rate for Payer: Cigna Commercial |
$1,612.18
|
| Rate for Payer: First Health Commercial |
$1,845.26
|
| Rate for Payer: Humana Commercial |
$1,651.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.14
|
| Rate for Payer: PHCS Commercial |
$1,864.68
|
| Rate for Payer: United Healthcare All Payer |
$1,709.29
|
|
|
APPROACH CTO 25 WIRE
|
Facility
|
OP
|
$1,942.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.51 |
| Max. Negotiated Rate |
$1,864.68 |
| Rate for Payer: Aetna Commercial |
$1,495.63
|
| Rate for Payer: Anthem Medicaid |
$667.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.06
|
| Rate for Payer: Cash Price |
$971.19
|
| Rate for Payer: Cigna Commercial |
$1,612.18
|
| Rate for Payer: First Health Commercial |
$1,845.26
|
| Rate for Payer: Humana Commercial |
$1,651.02
|
| Rate for Payer: Humana KY Medicaid |
$667.98
|
| Rate for Payer: Kentucky WC Medicaid |
$674.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.14
|
| Rate for Payer: PHCS Commercial |
$1,864.68
|
| Rate for Payer: United Healthcare All Payer |
$1,709.29
|
|
|
APPROACH HYDRO ST WIRE 300CM
|
Facility
|
OP
|
$2,058.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.63 |
| Max. Negotiated Rate |
$1,976.37 |
| Rate for Payer: Aetna Commercial |
$1,585.21
|
| Rate for Payer: Anthem Medicaid |
$707.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.80
|
| Rate for Payer: Cash Price |
$1,029.36
|
| Rate for Payer: Cigna Commercial |
$1,708.74
|
| Rate for Payer: First Health Commercial |
$1,955.78
|
| Rate for Payer: Humana Commercial |
$1,749.91
|
| Rate for Payer: Humana KY Medicaid |
$707.99
|
| Rate for Payer: Kentucky WC Medicaid |
$715.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.20
|
| Rate for Payer: PHCS Commercial |
$1,976.37
|
| Rate for Payer: United Healthcare All Payer |
$1,811.67
|
|
|
APPROACH HYDRO ST WIRE 300CM
|
Facility
|
IP
|
$2,058.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.63 |
| Max. Negotiated Rate |
$1,976.37 |
| Rate for Payer: Aetna Commercial |
$1,585.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.80
|
| Rate for Payer: Cash Price |
$1,029.36
|
| Rate for Payer: Cigna Commercial |
$1,708.74
|
| Rate for Payer: First Health Commercial |
$1,955.78
|
| Rate for Payer: Humana Commercial |
$1,749.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.20
|
| Rate for Payer: PHCS Commercial |
$1,976.37
|
| Rate for Payer: United Healthcare All Payer |
$1,811.67
|
|
|
APP SHORT ARM SPLINT (DYNAMIC)
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
76101052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
APP SHORT ARM SPLINT (DYNAMIC)
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
76101052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
APP SHORT ARM SPLINT (DYNAMIC)
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
45000189
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$64.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$64.31
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$64.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
APP SHORT ARM SPLINT (DYNAMIC)
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
45000189
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
APP SHORTARM SPLNT (STATIC)
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
76101051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
APP SHORTARM SPLNT (STATIC)
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
76101051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem Medicaid |
$222.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Humana KY Medicaid |
$222.85
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$225.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
APP SHORTARM SPLNT (STATIC)
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
45000188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
APP SHORTARM SPLNT (STATIC)
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
45000188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$64.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$64.31
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$64.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
APP SHORTARM SPLNT (STATIC)
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
76101051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$61.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.44
|
| Rate for Payer: Anthem Medicaid |
$23.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$648.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$102.82
|
| Rate for Payer: Healthspan PPO |
$82.39
|
| Rate for Payer: Humana Medicaid |
$23.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.96
|
| Rate for Payer: Molina Healthcare Passport |
$23.49
|
| Rate for Payer: Multiplan PHCS |
$388.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.60
|
| Rate for Payer: UHCCP Medicaid |
$33.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.72
|
|
|
APP SHORTARM SPLNT (STATIC)(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
761P1051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$61.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.44
|
| Rate for Payer: Anthem Medicaid |
$23.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$102.82
|
| Rate for Payer: Healthspan PPO |
$82.39
|
| Rate for Payer: Humana Medicaid |
$23.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.96
|
| Rate for Payer: Molina Healthcare Passport |
$23.49
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$33.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.72
|
|
|
APP SHORTARM SPLNT (STATIC)(T
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
761T1051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
APP SHORTARM SPLNT (STATIC)(T
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
761T1051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$119.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Humana KY Medicaid |
$119.68
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$120.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.88
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
APP SHORT LEG CAS(KNEE TO TOES
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
76101060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
APP SHORT LEG CAS(KNEE TO TOES
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
76101060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.61
|
| Rate for Payer: Anthem Medicaid |
$38.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$136.41
|
| Rate for Payer: Healthspan PPO |
$111.68
|
| Rate for Payer: Humana Medicaid |
$38.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.52
|
| Rate for Payer: Molina Healthcare Passport |
$38.75
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$49.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.14
|
|
|
APP SHORT LEG CAS(KNEE TO TOES
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
761T1060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
