|
OSTEOCHONDRAL ALLOGRAFT, KNEE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
76100836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$2,239.67 |
| Rate for Payer: Aetna Commercial |
$2,113.72
|
| Rate for Payer: Ambetter Exchange |
$1,303.99
|
| Rate for Payer: Anthem Medicaid |
$980.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,303.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,303.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,564.79
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,239.67
|
| Rate for Payer: Healthspan PPO |
$1,914.58
|
| Rate for Payer: Humana Medicaid |
$980.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,303.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,000.60
|
| Rate for Payer: Molina Healthcare Passport |
$980.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,695.19
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$990.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,303.99
|
|
|
OSTEOCHONDRAL ALLOGRAFT, KNEE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
76100836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.70 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,500.00
|
| 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: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| 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 |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| 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
|
|
|
OSTEOCHONDRAL ALLOGRAFT, KNE(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
761P0836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$2,239.67 |
| Rate for Payer: Aetna Commercial |
$2,113.72
|
| Rate for Payer: Ambetter Exchange |
$1,303.99
|
| Rate for Payer: Anthem Medicaid |
$980.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,303.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,303.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,564.79
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,239.67
|
| Rate for Payer: Healthspan PPO |
$1,914.58
|
| Rate for Payer: Humana Medicaid |
$980.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,303.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,000.60
|
| Rate for Payer: Molina Healthcare Passport |
$980.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,695.19
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$990.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,303.99
|
|
|
OSTEOCHONDRAL CORE 16MM
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,350.00 |
| Max. Negotiated Rate |
$23,520.00 |
| Rate for Payer: Aetna Commercial |
$18,865.00
|
| Rate for Payer: Anthem Medicaid |
$8,425.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,110.00
|
| Rate for Payer: Cash Price |
$12,250.00
|
| Rate for Payer: Cigna Commercial |
$20,335.00
|
| Rate for Payer: First Health Commercial |
$23,275.00
|
| Rate for Payer: Humana Commercial |
$20,825.00
|
| Rate for Payer: Humana KY Medicaid |
$8,425.55
|
| Rate for Payer: Kentucky WC Medicaid |
$8,511.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,081.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,594.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,315.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,905.00
|
| Rate for Payer: PHCS Commercial |
$23,520.00
|
| Rate for Payer: United Healthcare All Payer |
$21,560.00
|
|
|
OSTEOCHONDRAL CORE 16MM
|
Facility
|
IP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,350.00 |
| Max. Negotiated Rate |
$23,520.00 |
| Rate for Payer: Aetna Commercial |
$18,865.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,110.00
|
| Rate for Payer: Cash Price |
$12,250.00
|
| Rate for Payer: Cigna Commercial |
$20,335.00
|
| Rate for Payer: First Health Commercial |
$23,275.00
|
| Rate for Payer: Humana Commercial |
$20,825.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,081.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,315.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,905.00
|
| Rate for Payer: PHCS Commercial |
$23,520.00
|
| Rate for Payer: United Healthcare All Payer |
$21,560.00
|
|
|
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: Ambetter Exchange |
$933.84
|
| Rate for Payer: Anthem Medicaid |
$733.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$933.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$933.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,120.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$933.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.84
|
| 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 |
$1,213.99
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$933.84
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
76100837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.50 |
| 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 |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| 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 |
$407.52 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| 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: Ambetter Exchange |
$933.84
|
| Rate for Payer: Anthem Medicaid |
$733.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$933.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$933.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,120.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$933.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.84
|
| 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 |
$1,213.99
|
| Rate for Payer: UHCCP Medicaid |
$414.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$933.84
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
IP
|
$3,013.00
|
|
|
Service Code
|
HCPCS 28446
|
| Hospital Charge Code |
76102897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.90 |
| 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 |
$2,410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,621.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.97
|
| 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 |
$1,831.23 |
| Rate for Payer: Aetna Commercial |
$1,754.66
|
| Rate for Payer: Ambetter Exchange |
$1,163.82
|
| Rate for Payer: Anthem Medicaid |
$899.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,163.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,163.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,396.58
|
| 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 |
$1,589.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,163.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.82
|
| 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 |
$1,512.97
|
| Rate for Payer: UHCCP Medicaid |
$1,054.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$908.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,163.82
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
OP
|
$3,013.00
|
|
|
Service Code
|
HCPCS 28446
|
| Hospital Charge Code |
76102897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,036.17 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$2,320.01
|
| Rate for Payer: Anthem Medicaid |
$1,036.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,350.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$2,410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,621.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.97
|
| Rate for Payer: PHCS Commercial |
$2,892.48
|
| Rate for Payer: United Healthcare All Payer |
$2,651.44
|
|
|
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: Ambetter Exchange |
$907.05
|
| Rate for Payer: Anthem Medicaid |
$721.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$907.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$907.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,088.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$907.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$907.05
|
| 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 |
$1,179.16
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$729.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$907.05
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
76100470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| 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 |
$11,888.68
|
| 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 |
$14,266.42
|
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
OSTEO CLAV WWOINTFIX WBNEGRF
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
76100470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| 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: Ambetter Exchange |
$907.05
|
| Rate for Payer: Anthem Medicaid |
$721.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$907.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$907.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,088.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$907.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$907.05
|
| 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 |
$1,179.16
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$729.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$907.05
|
|
|
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 |
$3,603.00 |
| Rate for Payer: Aetna Commercial |
$1,455.06
|
| Rate for Payer: Ambetter Exchange |
$1,003.85
|
| Rate for Payer: Anthem Medicaid |
$757.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,003.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,003.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,204.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,003.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.85
|
| 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 |
$1,305.01
|
| Rate for Payer: UHCCP Medicaid |
$2,101.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,003.85
|
|
|
OSTEOTOME FLEXIBLE 12*120
|
Facility
|
IP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
OSTEOTOME FLEXIBLE 12*120
|
Facility
|
OP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem Medicaid |
$1,082.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Humana KY Medicaid |
$1,082.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
OSTEOTOME FLEXIBLE 12*93
|
Facility
|
IP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
OSTEOTOME FLEXIBLE 12*93
|
Facility
|
OP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem Medicaid |
$1,082.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Humana KY Medicaid |
$1,082.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
OSTEOTOME FLEXIBLE 8*80
|
Facility
|
IP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
OSTEOTOME FLEXIBLE 8*80
|
Facility
|
OP
|
$3,148.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.53 |
| Max. Negotiated Rate |
$3,022.50 |
| Rate for Payer: Aetna Commercial |
$2,424.30
|
| Rate for Payer: Anthem Medicaid |
$1,082.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.78
|
| Rate for Payer: Cash Price |
$1,574.22
|
| Rate for Payer: Cigna Commercial |
$2,613.21
|
| Rate for Payer: First Health Commercial |
$2,991.02
|
| Rate for Payer: Humana Commercial |
$2,676.17
|
| Rate for Payer: Humana KY Medicaid |
$1,082.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,581.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,323.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,770.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,361.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,739.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,172.42
|
| Rate for Payer: PHCS Commercial |
$3,022.50
|
| Rate for Payer: United Healthcare All Payer |
$2,770.63
|
|
|
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 |
$642.00 |
| Rate for Payer: Aetna Commercial |
$571.49
|
| Rate for Payer: Ambetter Exchange |
$385.83
|
| Rate for Payer: Anthem Medicaid |
$255.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$385.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$385.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$463.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$385.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.83
|
| 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 |
$501.58
|
| Rate for Payer: UHCCP Medicaid |
$374.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$385.83
|
|
|
OSTEOTOMY; FIBULA
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
76100917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.00 |
| 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 |
$856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.30
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
