|
CAST SUP LNG LEG SPLNT PED P
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4043
|
| Hospital Charge Code |
27000171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$12.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.49
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.24
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.49
|
|
|
CAST SUP LNG LEG SPLNT PLSTR
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS Q4041
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$24.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.98
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.98
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.47
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.98
|
|
|
CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: Ambetter Exchange |
$36.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.76
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.47
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.41
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.47
|
|
|
CAST SUP LONG ARM ADULT PLST
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS Q4005
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$16.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.19
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.05
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.19
|
|
|
CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$52.83 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: Ambetter Exchange |
$18.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.88
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.23
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.70
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.23
|
|
|
CAST SUP LONG ARM PED PLSTER
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4007
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$8.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.09
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.52
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.09
|
|
|
CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$123.53 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: Ambetter Exchange |
$95.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.02
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.53
|
| Rate for Payer: UHCCP Medicaid |
$47.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.02
|
|
|
CAST SUP LONG LEG PLASTER
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS Q4029
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$36.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.32
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.10
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.93
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.10
|
|
|
CAST SUPPLIES UNLISTED
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4050
|
| Hospital Charge Code |
27000177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.34
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
|
|
CAST SUP SHOULDER CAST FBRGL
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS Q4004
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$197.59 |
| Rate for Payer: Aetna Commercial |
$52.83
|
| Rate for Payer: Ambetter Exchange |
$151.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.39
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.99
|
| Rate for Payer: Multiplan PHCS |
$102.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.59
|
| Rate for Payer: UHCCP Medicaid |
$59.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.99
|
|
|
CAST SUP SHOULDER CAST PLSTR
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS Q4003
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$57.07 |
| Rate for Payer: Aetna Commercial |
$32.02
|
| Rate for Payer: Ambetter Exchange |
$43.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.68
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.90
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.07
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.90
|
|
|
CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
27000166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$51.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.74
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.45
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.89
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.45
|
|
|
CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$25.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.86
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.72
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.44
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.72
|
|
|
CAST SUP SHRT LEG PED PLSTER
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4039
|
| Hospital Charge Code |
27000167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$10.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.29
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.29
|
|
|
CAST SUP SHRT LEG PLASTER
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS Q4037
|
| Hospital Charge Code |
27000165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$20.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.61
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.51
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.66
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.51
|
|
|
CAST SUP SHRT LEG SPLNT PED PL
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Hospital Charge Code |
27000248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$7.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.66
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.22
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.39
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.22
|
|
|
CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Hospital Charge Code |
27000140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$24.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.17
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.31
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.60
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.31
|
|
|
CAST SUP SHT ARM ADULT PLSTR
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS Q4009
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$10.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.81
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.05
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.81
|
|
|
CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Hospital Charge Code |
27000142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$12.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.63
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.19
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.85
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.19
|
|
|
CAST SUP SHT ARM PED PLASTER
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS Q4011
|
| Hospital Charge Code |
27000141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$5.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.39
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.01
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.39
|
|
|
CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$15.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.24
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.20
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.76
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.20
|
|
|
CAST SUP SHT ARM SPLINT PLST
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4021
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$8.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.10
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.42
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.95
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.42
|
|
|
CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
27000154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$7.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.13
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.61
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.89
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.61
|
|
|
CAST SUP SHT ARM SPLNT PED P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS Q4023
|
| Hospital Charge Code |
27000153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$4.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.23
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.23
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Ambetter Exchange |
$23.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.98
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.32
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.32
|
|
