|
OSTEOTOMY; FIBULA
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
76100917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$535.00
|
| 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: Humana KY Medicaid |
$367.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$371.72
|
| 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 |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.36
|
| 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
|
|
|
OSTEOTOMY; FIBULA(P
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
761P0917
|
|
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, RADIUS DISTAL 3RD
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25350
|
| Hospital Charge Code |
76100608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OSTEOTOMY, RADIUS DISTAL 3RD
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25350
|
| Hospital Charge Code |
76100608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OSTEOTOMY, RADIUS DISTAL 3RD
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25350
|
| Hospital Charge Code |
76100608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.23 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Anthem Medicaid |
$476.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,430.04
|
| Rate for Payer: Healthspan PPO |
$973.30
|
| Rate for Payer: Humana Medicaid |
$476.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$869.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.75
|
| Rate for Payer: Molina Healthcare Passport |
$476.23
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.99
|
|
|
OSTEOTOMY, RADIUS; DISTAL 3R(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25350
|
| Hospital Charge Code |
761P0608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.23 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Anthem Medicaid |
$476.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,430.04
|
| Rate for Payer: Healthspan PPO |
$973.30
|
| Rate for Payer: Humana Medicaid |
$476.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$869.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.75
|
| Rate for Payer: Molina Healthcare Passport |
$476.23
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.99
|
|
|
OSTEOTOMY; TIBIA
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
76100916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,143.29
|
| Rate for Payer: Anthem Medicaid |
$613.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,251.25
|
| Rate for Payer: Healthspan PPO |
$1,035.58
|
| Rate for Payer: Humana Medicaid |
$613.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$951.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$625.68
|
| Rate for Payer: Molina Healthcare Passport |
$613.41
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$619.54
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
76100916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
76100916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OSTEOTOMY; TIBIA AND FIBULA
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
HCPCS 27709
|
| Hospital Charge Code |
76100918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$2,409.60 |
| Rate for Payer: Aetna Commercial |
$1,932.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,957.80
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cigna Commercial |
$2,083.30
|
| Rate for Payer: First Health Commercial |
$2,384.50
|
| Rate for Payer: Humana Commercial |
$2,133.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,058.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,852.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$753.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,208.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,882.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$502.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$778.10
|
| Rate for Payer: PHCS Commercial |
$2,409.60
|
| Rate for Payer: United Healthcare All Payer |
$2,208.80
|
|
|
OSTEOTOMY; TIBIA AND FIBULA
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
HCPCS 27709
|
| Hospital Charge Code |
76100918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,932.70
|
| Rate for Payer: Anthem Medicaid |
$863.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,957.80
|
| 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 |
$1,255.00
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cigna Commercial |
$2,083.30
|
| Rate for Payer: First Health Commercial |
$2,384.50
|
| Rate for Payer: Humana Commercial |
$2,133.50
|
| Rate for Payer: Humana KY Medicaid |
$863.19
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$871.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,058.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,852.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$880.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,208.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,882.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$502.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$778.10
|
| Rate for Payer: PHCS Commercial |
$2,409.60
|
| Rate for Payer: United Healthcare All Payer |
$2,208.80
|
|
|
OSTEOTOMY; TIBIA AND FIBULA
|
Professional
|
Both
|
$2,510.00
|
|
|
Service Code
|
HCPCS 27709
|
| Hospital Charge Code |
76100918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.02 |
| Max. Negotiated Rate |
$2,510.00 |
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Anthem Medicaid |
$634.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,510.00
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cigna Commercial |
$1,687.38
|
| Rate for Payer: Healthspan PPO |
$1,489.09
|
| Rate for Payer: Humana Medicaid |
$634.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,458.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.70
|
| Rate for Payer: Molina Healthcare Passport |
$634.02
|
| Rate for Payer: Multiplan PHCS |
$1,506.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,757.00
|
| Rate for Payer: UHCCP Medicaid |
$878.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.36
|
|
|
OSTEOTOMY; TIBIA AND FIBULA(P
|
Professional
|
Both
|
$2,510.00
|
|
|
Service Code
|
HCPCS 27709
|
| Hospital Charge Code |
761P0918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.02 |
| Max. Negotiated Rate |
$2,510.00 |
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Anthem Medicaid |
$634.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,510.00
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cash Price |
$1,255.00
|
| Rate for Payer: Cigna Commercial |
$1,687.38
|
| Rate for Payer: Healthspan PPO |
$1,489.09
|
| Rate for Payer: Humana Medicaid |
$634.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,458.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.70
|
| Rate for Payer: Molina Healthcare Passport |
$634.02
|
| Rate for Payer: Multiplan PHCS |
$1,506.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,757.00
|
| Rate for Payer: UHCCP Medicaid |
$878.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.36
|
|
|
OSTEOTOMY; TIBIA(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
761P0916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,143.29
|
| Rate for Payer: Anthem Medicaid |
$613.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,251.25
|
| Rate for Payer: Healthspan PPO |
$1,035.58
|
| Rate for Payer: Humana Medicaid |
$613.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$951.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$625.68
|
| Rate for Payer: Molina Healthcare Passport |
$613.41
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$619.54
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
76100609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OSTEOTOMY; ULNA
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
76100609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.21 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,042.21
|
| Rate for Payer: Anthem Medicaid |
$427.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,397.98
|
| Rate for Payer: Healthspan PPO |
$944.02
|
| Rate for Payer: Humana Medicaid |
$427.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$846.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$435.75
|
| Rate for Payer: Molina Healthcare Passport |
$427.21
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.48
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
76100609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OSTEOTOMY; ULNA(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
761P0609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.21 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,042.21
|
| Rate for Payer: Anthem Medicaid |
$427.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,397.98
|
| Rate for Payer: Healthspan PPO |
$944.02
|
| Rate for Payer: Humana Medicaid |
$427.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$846.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$435.75
|
| Rate for Payer: Molina Healthcare Passport |
$427.21
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.48
|
|
|
OSTEOTOMY - WITH OR WITHOUT L
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
76101006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OSTEOTOMY - WITH OR WITHOUT L
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
76101006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$616.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.56
|
| Rate for Payer: Anthem Medicaid |
$301.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$665.08
|
| Rate for Payer: Healthspan PPO |
$751.03
|
| Rate for Payer: Humana Medicaid |
$301.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.58
|
| Rate for Payer: Molina Healthcare Passport |
$301.55
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$215.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.57
|
|
|
OSTEOTOMY - WITH OR WITHOUT L
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
76101006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
OSTEOTOMY - WITH OR WITHOUT (P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
761P1006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$616.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.56
|
| Rate for Payer: Anthem Medicaid |
$301.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$665.08
|
| Rate for Payer: Healthspan PPO |
$751.03
|
| Rate for Payer: Humana Medicaid |
$301.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.58
|
| Rate for Payer: Molina Healthcare Passport |
$301.55
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$215.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.57
|
|
|
OS TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 84410
|
| Hospital Charge Code |
30001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 84410
|
| Hospital Charge Code |
30001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$51.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.28
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$51.28
|
| Rate for Payer: Humana Medicare Advantage |
$51.28
|
| Rate for Payer: Kentucky WC Medicaid |
$51.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
