|
OSTEOTOMY; FIBULA
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27707
|
| Hospital Charge Code |
76100917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$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
|
|
|
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 |
$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, 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 |
$1,430.04 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Ambetter Exchange |
$644.29
|
| Rate for Payer: Anthem Medicaid |
$476.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$644.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.29
|
| 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 |
$837.58
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.29
|
|
|
OSTEOTOMY, RADIUS DISTAL 3RD
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25350
|
| Hospital Charge Code |
76100608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| 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 |
$480.00 |
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
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 |
$1,430.04 |
| Rate for Payer: Aetna Commercial |
$1,074.53
|
| Rate for Payer: Ambetter Exchange |
$644.29
|
| Rate for Payer: Anthem Medicaid |
$476.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$644.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.29
|
| 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 |
$837.58
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.29
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
76100916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
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 |
$1,251.25 |
| Rate for Payer: Aetna Commercial |
$1,143.29
|
| Rate for Payer: Ambetter Exchange |
$707.46
|
| Rate for Payer: Anthem Medicaid |
$613.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$707.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.46
|
| 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 |
$919.70
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$619.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.46
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
76100916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| 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 |
$753.00 |
| 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 |
$2,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,183.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,731.90
|
| 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 |
$863.19 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,932.70
|
| Rate for Payer: Anthem Medicaid |
$863.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,957.80
|
| 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 |
$1,255.00
|
| 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 |
$11,888.68
|
| 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 |
$14,266.42
|
| 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 |
$2,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,183.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,731.90
|
| 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 |
$1,687.38 |
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Ambetter Exchange |
$1,083.63
|
| Rate for Payer: Anthem Medicaid |
$634.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,083.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,083.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,300.36
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,083.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.63
|
| 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 |
$1,408.72
|
| Rate for Payer: UHCCP Medicaid |
$878.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,083.63
|
|
|
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 |
$1,687.38 |
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Ambetter Exchange |
$1,083.63
|
| Rate for Payer: Anthem Medicaid |
$634.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,083.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,083.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,300.36
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,083.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.63
|
| 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 |
$1,408.72
|
| Rate for Payer: UHCCP Medicaid |
$878.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,083.63
|
|
|
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 |
$1,251.25 |
| Rate for Payer: Aetna Commercial |
$1,143.29
|
| Rate for Payer: Ambetter Exchange |
$707.46
|
| Rate for Payer: Anthem Medicaid |
$613.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$707.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.46
|
| 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 |
$919.70
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$619.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.46
|
|
|
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 |
$1,397.98 |
| Rate for Payer: Aetna Commercial |
$1,042.21
|
| Rate for Payer: Ambetter Exchange |
$627.41
|
| Rate for Payer: Anthem Medicaid |
$427.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$627.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$627.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$752.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$627.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.41
|
| 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 |
$815.63
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$627.41
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
76100609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25360
|
| Hospital Charge Code |
76100609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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 |
$1,397.98 |
| Rate for Payer: Aetna Commercial |
$1,042.21
|
| Rate for Payer: Ambetter Exchange |
$627.41
|
| Rate for Payer: Anthem Medicaid |
$427.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$627.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$627.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$752.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$627.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.41
|
| 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 |
$815.63
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$627.41
|
|
|
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 |
$343.90 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$751.03 |
| Rate for Payer: Aetna Commercial |
$616.12
|
| Rate for Payer: Ambetter Exchange |
$386.71
|
| 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 Individual/Medicaid |
$386.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$386.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$464.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.71
|
| 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 |
$502.72
|
| Rate for Payer: UHCCP Medicaid |
$215.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$386.71
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28308
|
|
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
|
|
|
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 |
$751.03 |
| Rate for Payer: Aetna Commercial |
$616.12
|
| Rate for Payer: Ambetter Exchange |
$386.71
|
| 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 Individual/Medicaid |
$386.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$386.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$464.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.71
|
| 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 |
$502.72
|
| Rate for Payer: UHCCP Medicaid |
$215.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$386.71
|
|
|
OS TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 84410
|
| Hospital Charge Code |
30001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
OS TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 84410
|
| Hospital Charge Code |
30001909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$51.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.28
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| 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 |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
