|
OSTECTOMY - COMPLETE EXCISION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
76100981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
OSTECTOMY - COMPLETE EXCISION
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
76100981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Aetna Commercial |
$483.21
|
| Rate for Payer: Ambetter Exchange |
$297.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$241.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$357.48
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$530.17
|
| Rate for Payer: Healthspan PPO |
$603.00
|
| Rate for Payer: Humana Medicaid |
$241.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$391.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$297.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.10
|
| Rate for Payer: Molina Healthcare Passport |
$241.27
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$387.27
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.90
|
|
|
OSTECTOMY - COMPLETE EXCISION
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
76100981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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: 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 |
$210.00
|
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
OSTECTOMY - COMPLETE EXCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28111
|
| Hospital Charge Code |
76100980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.03 |
| Max. Negotiated Rate |
$638.90 |
| Rate for Payer: Aetna Commercial |
$518.03
|
| Rate for Payer: Ambetter Exchange |
$303.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.03
|
| Rate for Payer: Anthem Medicaid |
$287.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.61
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$569.76
|
| Rate for Payer: Healthspan PPO |
$638.90
|
| Rate for Payer: Humana Medicaid |
$287.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.87
|
| Rate for Payer: Molina Healthcare Passport |
$287.13
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.91
|
| Rate for Payer: UHCCP Medicaid |
$175.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.01
|
|
|
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
OSTECTOMY - COMPLETE EXCISIO(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28112
|
| Hospital Charge Code |
761P0981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Aetna Commercial |
$483.21
|
| Rate for Payer: Ambetter Exchange |
$297.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$241.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$357.48
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$530.17
|
| Rate for Payer: Healthspan PPO |
$603.00
|
| Rate for Payer: Humana Medicaid |
$241.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$391.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$297.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.10
|
| Rate for Payer: Molina Healthcare Passport |
$241.27
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$387.27
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.90
|
|
|
OSTECTOMY - COMPLETE EXCISIO(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28111
|
| Hospital Charge Code |
761P0980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.03 |
| Max. Negotiated Rate |
$638.90 |
| Rate for Payer: Aetna Commercial |
$518.03
|
| Rate for Payer: Ambetter Exchange |
$303.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.03
|
| Rate for Payer: Anthem Medicaid |
$287.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.61
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$569.76
|
| Rate for Payer: Healthspan PPO |
$638.90
|
| Rate for Payer: Humana Medicaid |
$287.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.87
|
| Rate for Payer: Molina Healthcare Passport |
$287.13
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.91
|
| Rate for Payer: UHCCP Medicaid |
$175.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.01
|
|
|
OSTECTOMY OF STERNUM, PARTIAL
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 21620
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.85 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$762.49
|
| Rate for Payer: Ambetter Exchange |
$476.75
|
| Rate for Payer: Anthem Medicaid |
$390.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.10
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$847.89
|
| Rate for Payer: Healthspan PPO |
$690.65
|
| Rate for Payer: Humana Medicaid |
$390.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.67
|
| Rate for Payer: Molina Healthcare Passport |
$390.85
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.77
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.75
|
|
|
OSTECTOMY OF STERNUM, PARTIAL
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 21620
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
OSTECTOMY OF STERNUM, PARTIAL
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 21620
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
OSTECTOMY OF STERNUM, PARTIA(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 21620
|
| Hospital Charge Code |
761P0401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.85 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$762.49
|
| Rate for Payer: Ambetter Exchange |
$476.75
|
| Rate for Payer: Anthem Medicaid |
$390.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.10
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$847.89
|
| Rate for Payer: Healthspan PPO |
$690.65
|
| Rate for Payer: Humana Medicaid |
$390.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.67
|
| Rate for Payer: Molina Healthcare Passport |
$390.85
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.77
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.75
|
|
|
OSTECTOMY - PARTIAL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
76101001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$632.16
|
| Rate for Payer: Ambetter Exchange |
$411.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.96
|
| Rate for Payer: Anthem Medicaid |
$220.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$411.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$411.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$493.78
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$693.65
|
| Rate for Payer: Healthspan PPO |
$721.43
|
| Rate for Payer: Humana Medicaid |
$220.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$411.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.89
|
| Rate for Payer: Molina Healthcare Passport |
$220.48
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.92
|
| Rate for Payer: UHCCP Medicaid |
$232.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$411.48
|
|
|
OSTECTOMY - PARTIAL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
76101001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
OSTECTOMY - PARTIAL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
76101001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
OSTECTOMY - PARTIAL(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
761P1001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$632.16
|
| Rate for Payer: Ambetter Exchange |
$411.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.96
|
| Rate for Payer: Anthem Medicaid |
$220.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$411.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$411.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$493.78
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$693.65
|
| Rate for Payer: Healthspan PPO |
$721.43
|
| Rate for Payer: Humana Medicaid |
$220.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$411.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.89
|
| Rate for Payer: Molina Healthcare Passport |
$220.48
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.92
|
| Rate for Payer: UHCCP Medicaid |
$232.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$411.48
|
|
|
OSTEOAUGER HARVESTER 8MM
|
Facility
|
OP
|
$4,118.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,235.62 |
| Max. Negotiated Rate |
$3,954.00 |
| Rate for Payer: Aetna Commercial |
$3,171.44
|
| Rate for Payer: Anthem Medicaid |
$1,416.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.62
|
| Rate for Payer: Cash Price |
$2,059.38
|
| Rate for Payer: Cigna Commercial |
$3,418.56
|
| Rate for Payer: First Health Commercial |
$3,912.81
|
| Rate for Payer: Humana Commercial |
$3,500.94
|
| Rate for Payer: Humana KY Medicaid |
$1,416.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,430.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,444.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,841.94
|
| Rate for Payer: PHCS Commercial |
$3,954.00
|
| Rate for Payer: United Healthcare All Payer |
$3,624.50
|
|
|
OSTEOAUGER HARVESTER 8MM
|
Facility
|
IP
|
$4,118.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,235.62 |
| Max. Negotiated Rate |
$3,954.00 |
| Rate for Payer: Aetna Commercial |
$3,171.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.62
|
| Rate for Payer: Cash Price |
$2,059.38
|
| Rate for Payer: Cigna Commercial |
$3,418.56
|
| Rate for Payer: First Health Commercial |
$3,912.81
|
| Rate for Payer: Humana Commercial |
$3,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,841.94
|
| Rate for Payer: PHCS Commercial |
$3,954.00
|
| Rate for Payer: United Healthcare All Payer |
$3,624.50
|
|
|
OSTEOCHON AUTOGRAFT TRANS 10MM
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHON AUTOGRAFT TRANS 10MM
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHON AUTOGRAFT TRANS 6MM
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHON AUTOGRAFT TRANS 6MM
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHON AUTOGRAFT TRANS 8MM
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHON AUTOGRAFT TRANS 8MM
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
OSTEOCHONDRAL ALLOGRAFT, KNEE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
76100836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
