|
OSTEOCHONDRAL CORE 16MM
|
Facility
|
OP
|
$23,780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$22,828.80 |
| Rate for Payer: Aetna Commercial |
$18,310.60
|
| Rate for Payer: Anthem Medicaid |
$8,177.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,548.40
|
| Rate for Payer: Cash Price |
$11,890.00
|
| Rate for Payer: Cigna Commercial |
$19,737.40
|
| Rate for Payer: First Health Commercial |
$22,591.00
|
| Rate for Payer: Humana Commercial |
$20,213.00
|
| Rate for Payer: Humana KY Medicaid |
$8,177.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,261.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,549.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,134.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,342.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,926.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,835.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,371.80
|
| Rate for Payer: PHCS Commercial |
$22,828.80
|
| Rate for Payer: United Healthcare All Payer |
$20,926.40
|
|
|
OSTEOCHONDRAL CORE 16MM
|
Facility
|
IP
|
$23,780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$22,828.80 |
| Rate for Payer: Aetna Commercial |
$18,310.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,548.40
|
| Rate for Payer: Cash Price |
$11,890.00
|
| Rate for Payer: Cigna Commercial |
$19,737.40
|
| Rate for Payer: First Health Commercial |
$22,591.00
|
| Rate for Payer: Humana Commercial |
$20,213.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,549.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,134.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,926.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,835.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,371.80
|
| Rate for Payer: PHCS Commercial |
$22,828.80
|
| Rate for Payer: United Healthcare All Payer |
$20,926.40
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAF(P
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
761P0837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.75 |
| Max. Negotiated Rate |
$1,494.54 |
| Rate for Payer: Aetna Commercial |
$1,437.36
|
| Rate for Payer: Anthem Medicaid |
$733.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.00
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,494.54
|
| Rate for Payer: Healthspan PPO |
$1,301.94
|
| Rate for Payer: Humana Medicaid |
$733.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.81
|
| Rate for Payer: Molina Healthcare Passport |
$733.15
|
| Rate for Payer: Multiplan PHCS |
$711.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$829.50
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.48
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
76100837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.35
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
76100837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Humana KY Medicaid |
$407.52
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$411.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.35
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
76100837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.75 |
| Max. Negotiated Rate |
$1,494.54 |
| Rate for Payer: Aetna Commercial |
$1,437.36
|
| Rate for Payer: Anthem Medicaid |
$733.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.00
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,494.54
|
| Rate for Payer: Healthspan PPO |
$1,301.94
|
| Rate for Payer: Humana Medicaid |
$733.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.81
|
| Rate for Payer: Molina Healthcare Passport |
$733.15
|
| Rate for Payer: Multiplan PHCS |
$711.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$829.50
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.48
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
IP
|
$3,013.00
|
|
|
Service Code
|
HCPCS 28446
|
| Hospital Charge Code |
76102897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.69 |
| Max. Negotiated Rate |
$2,892.48 |
| Rate for Payer: Aetna Commercial |
$2,320.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,350.14
|
| Rate for Payer: Cash Price |
$1,506.50
|
| Rate for Payer: Cigna Commercial |
$2,500.79
|
| Rate for Payer: First Health Commercial |
$2,862.35
|
| Rate for Payer: Humana Commercial |
$2,561.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$934.03
|
| Rate for Payer: PHCS Commercial |
$2,892.48
|
| Rate for Payer: United Healthcare All Payer |
$2,651.44
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
OP
|
$3,013.00
|
|
|
Service Code
|
HCPCS 28446
|
| Hospital Charge Code |
76102897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.69 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$2,320.01
|
| Rate for Payer: Anthem Medicaid |
$1,036.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,350.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,506.50
|
| Rate for Payer: Cash Price |
$1,506.50
|
| Rate for Payer: Cigna Commercial |
$2,500.79
|
| Rate for Payer: First Health Commercial |
$2,862.35
|
| Rate for Payer: Humana Commercial |
$2,561.05
|
| Rate for Payer: Humana KY Medicaid |
$1,036.17
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,046.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,470.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,223.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,056.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,651.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$934.03
|
| Rate for Payer: PHCS Commercial |
$2,892.48
|
| Rate for Payer: United Healthcare All Payer |
$2,651.44
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Professional
|
Both
|
$3,013.00
|
|
|
Service Code
|
HCPCS 28446
|
| Hospital Charge Code |
76102897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$899.30 |
| Max. Negotiated Rate |
$3,013.00 |
| Rate for Payer: Aetna Commercial |
$1,754.66
|
| Rate for Payer: Anthem Medicaid |
$899.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,013.00
|
| Rate for Payer: Cash Price |
$1,506.50
|
| Rate for Payer: Cash Price |
$1,506.50
|
| Rate for Payer: Cigna Commercial |
$1,831.23
|
| Rate for Payer: Healthspan PPO |
$1,589.34
|
| Rate for Payer: Humana Medicaid |
$899.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,514.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$917.29
|
| Rate for Payer: Molina Healthcare Passport |
$899.30
|
| Rate for Payer: Multiplan PHCS |
$1,807.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,109.10
|
| Rate for Payer: UHCCP Medicaid |
$1,054.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$908.29
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
76100470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,570.30 |
| Rate for Payer: Aetna Commercial |
$1,440.58
|
| Rate for Payer: Anthem Medicaid |
$721.94
|
| 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 |
$1,570.30
|
| Rate for Payer: Healthspan PPO |
$1,304.86
|
| Rate for Payer: Humana Medicaid |
$721.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,199.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$736.38
|
| Rate for Payer: Molina Healthcare Passport |
$721.94
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$729.16
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
76100470
|
|
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 POS/PPO/Traditional |
$858.00
|
| 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: 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 |
$330.00
|
| 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
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
76100470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$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 |
$11,381.14
|
| 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 |
$13,657.37
|
| 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
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
761P0470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,570.30 |
| Rate for Payer: Aetna Commercial |
$1,440.58
|
| Rate for Payer: Anthem Medicaid |
$721.94
|
| 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 |
$1,570.30
|
| Rate for Payer: Healthspan PPO |
$1,304.86
|
| Rate for Payer: Humana Medicaid |
$721.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,199.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$736.38
|
| Rate for Payer: Molina Healthcare Passport |
$721.94
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$729.16
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
|
IP
|
$15,186.61
|
|
|
Service Code
|
MSDRG 540
|
| Min. Negotiated Rate |
$10,305.20 |
| Max. Negotiated Rate |
$15,186.61 |
| Rate for Payer: Anthem Medicaid |
$10,305.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,847.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,186.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,644.23
|
| Rate for Payer: Humana KY Medicaid |
$10,305.20
|
| Rate for Payer: Humana Medicare Advantage |
$10,847.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,408.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,017.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,511.31
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
|
IP
|
$23,213.93
|
|
|
Service Code
|
MSDRG 539
|
| Min. Negotiated Rate |
$15,752.31 |
| Max. Negotiated Rate |
$23,213.93 |
| Rate for Payer: Anthem Medicaid |
$15,752.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,581.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,213.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,384.86
|
| Rate for Payer: Humana KY Medicaid |
$15,752.31
|
| Rate for Payer: Humana Medicare Advantage |
$16,581.38
|
| Rate for Payer: Kentucky WC Medicaid |
$15,909.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,897.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,067.36
|
|
|
OSTEOMYELITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,035.89
|
|
|
Service Code
|
MSDRG 541
|
| Min. Negotiated Rate |
$6,810.07 |
| Max. Negotiated Rate |
$10,035.89 |
| Rate for Payer: Anthem Medicaid |
$6,810.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,168.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,035.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,677.46
|
| Rate for Payer: Humana KY Medicaid |
$6,810.07
|
| Rate for Payer: Humana Medicare Advantage |
$7,168.49
|
| Rate for Payer: Kentucky WC Medicaid |
$6,878.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,602.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,946.27
|
|
|
OSTEOPLASTY HUMERUS
|
Professional
|
Both
|
$6,005.00
|
|
|
Service Code
|
HCPCS 24420
|
| Hospital Charge Code |
51000292
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$757.28 |
| Max. Negotiated Rate |
$6,005.00 |
| Rate for Payer: Aetna Commercial |
$1,455.06
|
| Rate for Payer: Anthem Medicaid |
$757.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,005.00
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$1,586.02
|
| Rate for Payer: Healthspan PPO |
$1,317.98
|
| Rate for Payer: Humana Medicaid |
$757.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,230.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$772.43
|
| Rate for Payer: Molina Healthcare Passport |
$757.28
|
| Rate for Payer: Multiplan PHCS |
$3,603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,203.50
|
| Rate for Payer: UHCCP Medicaid |
$2,101.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.85
|
|
|
OSTEOTOME FLEXIBLE 12*120
|
Facility
|
IP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOME FLEXIBLE 12*120
|
Facility
|
OP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem Medicaid |
$1,125.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Humana KY Medicaid |
$1,125.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOME FLEXIBLE 12*93
|
Facility
|
IP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOME FLEXIBLE 12*93
|
Facility
|
OP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem Medicaid |
$1,125.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Humana KY Medicaid |
$1,125.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOME FLEXIBLE 8*80
|
Facility
|
OP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem Medicaid |
$1,125.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Humana KY Medicaid |
$1,125.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOME FLEXIBLE 8*80
|
Facility
|
IP
|
$3,271.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.34 |
| Max. Negotiated Rate |
$3,141.00 |
| Rate for Payer: Aetna Commercial |
$2,519.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,552.07
|
| Rate for Payer: Cash Price |
$1,635.94
|
| Rate for Payer: Cigna Commercial |
$2,715.66
|
| Rate for Payer: First Health Commercial |
$3,108.29
|
| Rate for Payer: Humana Commercial |
$2,781.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,879.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.28
|
| Rate for Payer: PHCS Commercial |
$3,141.00
|
| Rate for Payer: United Healthcare All Payer |
$2,879.25
|
|
|
OSTEOTOMY; FIBULA
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
76100917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.46 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$571.49
|
| Rate for Payer: Anthem Medicaid |
$255.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,070.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$630.08
|
| Rate for Payer: Healthspan PPO |
$517.65
|
| Rate for Payer: Humana Medicaid |
$255.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$494.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.57
|
| Rate for Payer: Molina Healthcare Passport |
$255.46
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.00
|
| Rate for Payer: UHCCP Medicaid |
$374.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.01
|
|
|
OSTEOTOMY; FIBULA
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
76100917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$1,027.20 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.70
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
