INPATIENT APRDRG 8161: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$6,621.65
|
|
Service Code
|
APR-DRG 8161
|
Hospital Charge Code |
APRDRG 8161
|
Min. Negotiated Rate |
$1,374.36 |
Max. Negotiated Rate |
$6,621.65 |
Rate for Payer: Buckeye Health Medicaid OOS |
$1,374.36
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6,621.65
|
Rate for Payer: Managed Health Services Medicaid |
$6,621.65
|
Rate for Payer: MDWise Medicaid |
$6,621.65
|
Rate for Payer: Molina Healthcare of OH Medicare |
$1,374.36
|
|
INPATIENT APRDRG 8162: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$8,471.62
|
|
Service Code
|
APR-DRG 8162
|
Hospital Charge Code |
APRDRG 8162
|
Min. Negotiated Rate |
$1,692.01 |
Max. Negotiated Rate |
$8,471.62 |
Rate for Payer: Buckeye Health Medicaid OOS |
$1,692.01
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8,471.62
|
Rate for Payer: Managed Health Services Medicaid |
$8,471.62
|
Rate for Payer: MDWise Medicaid |
$8,471.62
|
Rate for Payer: Molina Healthcare of OH Medicare |
$1,692.01
|
|
INPATIENT APRDRG 8163: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$10,016.96
|
|
Service Code
|
APR-DRG 8163
|
Hospital Charge Code |
APRDRG 8163
|
Min. Negotiated Rate |
$2,163.37 |
Max. Negotiated Rate |
$10,016.96 |
Rate for Payer: Buckeye Health Medicaid OOS |
$2,163.37
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10,016.96
|
Rate for Payer: Managed Health Services Medicaid |
$10,016.96
|
Rate for Payer: MDWise Medicaid |
$10,016.96
|
Rate for Payer: Molina Healthcare of OH Medicare |
$2,163.37
|
|
INPATIENT APRDRG 8164: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
IP
|
$22,031.89
|
|
Service Code
|
APR-DRG 8164
|
Hospital Charge Code |
APRDRG 8164
|
Min. Negotiated Rate |
$4,349.47 |
Max. Negotiated Rate |
$22,031.89 |
Rate for Payer: Buckeye Health Medicaid OOS |
$4,349.47
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$22,031.89
|
Rate for Payer: Managed Health Services Medicaid |
$22,031.89
|
Rate for Payer: MDWise Medicaid |
$22,031.89
|
Rate for Payer: Molina Healthcare of OH Medicare |
$4,349.47
|
|
INPATIENT APRDRG 8171: OVERDOSE
|
Facility
IP
|
$6,542.72
|
|
Service Code
|
APR-DRG 8171
|
Hospital Charge Code |
APRDRG 8171
|
Min. Negotiated Rate |
$1,369.56 |
Max. Negotiated Rate |
$6,542.72 |
Rate for Payer: Buckeye Health Medicaid OOS |
$1,369.56
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6,542.72
|
Rate for Payer: Managed Health Services Medicaid |
$6,542.72
|
Rate for Payer: MDWise Medicaid |
$6,542.72
|
Rate for Payer: Molina Healthcare of OH Medicare |
$1,369.56
|
|
INPATIENT APRDRG 8172: OVERDOSE
|
Facility
IP
|
$8,070.80
|
|
Service Code
|
APR-DRG 8172
|
Hospital Charge Code |
APRDRG 8172
|
Min. Negotiated Rate |
$1,670.24 |
Max. Negotiated Rate |
$8,070.80 |
Rate for Payer: Buckeye Health Medicaid OOS |
$1,670.24
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8,070.80
|
Rate for Payer: Managed Health Services Medicaid |
$8,070.80
|
Rate for Payer: MDWise Medicaid |
$8,070.80
|
Rate for Payer: Molina Healthcare of OH Medicare |
$1,670.24
|
|
INPATIENT APRDRG 8173: OVERDOSE
|
Facility
IP
|
$9,194.34
|
|
Service Code
|
APR-DRG 8173
|
Hospital Charge Code |
APRDRG 8173
|
Min. Negotiated Rate |
$2,283.45 |
Max. Negotiated Rate |
$9,194.34 |
Rate for Payer: Buckeye Health Medicaid OOS |
$2,283.45
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$9,194.34
|
Rate for Payer: Managed Health Services Medicaid |
$9,194.34
|
Rate for Payer: MDWise Medicaid |
$9,194.34
|
Rate for Payer: Molina Healthcare of OH Medicare |
$2,283.45
|
|
INPATIENT APRDRG 8174: OVERDOSE
|
Facility
IP
|
$21,040.31
|
|
Service Code
|
APR-DRG 8174
|
Hospital Charge Code |
APRDRG 8174
|
Min. Negotiated Rate |
$5,060.98 |
Max. Negotiated Rate |
$21,040.31 |
Rate for Payer: Buckeye Health Medicaid OOS |
$5,060.98
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21,040.31
|
Rate for Payer: Managed Health Services Medicaid |
$21,040.31
|
Rate for Payer: MDWise Medicaid |
$21,040.31
|
Rate for Payer: Molina Healthcare of OH Medicare |
$5,060.98
|
|
INPATIENT APRDRG 8411: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT
|
Facility
IP
|
$36,549.55
|
|
Service Code
|
APR-DRG 8411
|
Hospital Charge Code |
APRDRG 8411
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$36,549.55 |
Rate for Payer: Buckeye Health Medicaid OOS |
$36,549.55
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$36,549.55
|
|
INPATIENT APRDRG 8412: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT
|
Facility
IP
|
$36,549.55
|
|
Service Code
|
APR-DRG 8412
|
Hospital Charge Code |
APRDRG 8412
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$36,549.55 |
Rate for Payer: Buckeye Health Medicaid OOS |
$36,549.55
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$36,549.55
|
|
INPATIENT APRDRG 8413: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT
|
Facility
IP
|
$36,549.55
|
|
Service Code
|
APR-DRG 8413
|
Hospital Charge Code |
APRDRG 8413
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$36,549.55 |
Rate for Payer: Buckeye Health Medicaid OOS |
$36,549.55
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$36,549.55
|
|
INPATIENT APRDRG 8414: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT
|
Facility
IP
|
$36,549.55
|
|
Service Code
|
APR-DRG 8414
|
Hospital Charge Code |
APRDRG 8414
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$36,549.55 |
Rate for Payer: Buckeye Health Medicaid OOS |
$36,549.55
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$36,549.55
|
|
INPATIENT APRDRG 8421: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS
|
Facility
IP
|
$7,846.84
|
|
Service Code
|
APR-DRG 8421
|
Hospital Charge Code |
APRDRG 8421
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$7,846.84 |
Rate for Payer: Buckeye Health Medicaid OOS |
$7,846.84
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$7,846.84
|
|
INPATIENT APRDRG 8422: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS
|
Facility
IP
|
$10,672.41
|
|
Service Code
|
APR-DRG 8422
|
Hospital Charge Code |
APRDRG 8422
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$10,672.41 |
Rate for Payer: Buckeye Health Medicaid OOS |
$10,672.41
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$10,672.41
|
|
INPATIENT APRDRG 8423: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS
|
Facility
IP
|
$21,566.41
|
|
Service Code
|
APR-DRG 8423
|
Hospital Charge Code |
APRDRG 8423
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$21,566.41 |
Rate for Payer: Buckeye Health Medicaid OOS |
$21,566.41
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$21,566.41
|
|
INPATIENT APRDRG 8424: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS
|
Facility
IP
|
$24,142.53
|
|
Service Code
|
APR-DRG 8424
|
Hospital Charge Code |
APRDRG 8424
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$24,142.53 |
Rate for Payer: Buckeye Health Medicaid OOS |
$24,142.53
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$24,142.53
|
|
INPATIENT APRDRG 8431: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$2,361.58
|
|
Service Code
|
APR-DRG 8431
|
Hospital Charge Code |
APRDRG 8431
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$2,361.58 |
Rate for Payer: Buckeye Health Medicaid OOS |
$2,361.58
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$2,361.58
|
|
INPATIENT APRDRG 8432: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$3,547.65
|
|
Service Code
|
APR-DRG 8432
|
Hospital Charge Code |
APRDRG 8432
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$3,547.65 |
Rate for Payer: Buckeye Health Medicaid OOS |
$3,547.65
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$3,547.65
|
|
INPATIENT APRDRG 8433: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$7,345.39
|
|
Service Code
|
APR-DRG 8433
|
Hospital Charge Code |
APRDRG 8433
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$7,345.39 |
Rate for Payer: Buckeye Health Medicaid OOS |
$7,345.39
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$7,345.39
|
|
INPATIENT APRDRG 8434: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$7,345.39
|
|
Service Code
|
APR-DRG 8434
|
Hospital Charge Code |
APRDRG 8434
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$7,345.39 |
Rate for Payer: Buckeye Health Medicaid OOS |
$7,345.39
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$7,345.39
|
|
INPATIENT APRDRG 8441: PARTIAL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$1,994.61
|
|
Service Code
|
APR-DRG 8441
|
Hospital Charge Code |
APRDRG 8441
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$1,994.61 |
Rate for Payer: Buckeye Health Medicaid OOS |
$1,994.61
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$1,994.61
|
|
INPATIENT APRDRG 8442: PARTIAL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$3,039.79
|
|
Service Code
|
APR-DRG 8442
|
Hospital Charge Code |
APRDRG 8442
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$3,039.79 |
Rate for Payer: Buckeye Health Medicaid OOS |
$3,039.79
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$3,039.79
|
|
INPATIENT APRDRG 8443: PARTIAL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$7,166.07
|
|
Service Code
|
APR-DRG 8443
|
Hospital Charge Code |
APRDRG 8443
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$7,166.07 |
Rate for Payer: Buckeye Health Medicaid OOS |
$7,166.07
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$7,166.07
|
|
INPATIENT APRDRG 8444: PARTIAL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
IP
|
$7,166.07
|
|
Service Code
|
APR-DRG 8444
|
Hospital Charge Code |
APRDRG 8444
|
Min. Negotiated Rate |
$855.00 |
Max. Negotiated Rate |
$7,166.07 |
Rate for Payer: Buckeye Health Medicaid OOS |
$7,166.07
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$855.00
|
Rate for Payer: Managed Health Services Medicaid |
$855.00
|
Rate for Payer: MDWise Medicaid |
$855.00
|
Rate for Payer: Molina Healthcare of OH Medicare |
$7,166.07
|
|
INPATIENT APRDRG 8501: PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE
|
Facility
IP
|
$24,661.32
|
|
Service Code
|
APR-DRG 8501
|
Hospital Charge Code |
APRDRG 8501
|
Min. Negotiated Rate |
$6,370.02 |
Max. Negotiated Rate |
$24,661.32 |
Rate for Payer: Buckeye Health Medicaid OOS |
$6,370.02
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$24,661.32
|
Rate for Payer: Managed Health Services Medicaid |
$24,661.32
|
Rate for Payer: MDWise Medicaid |
$24,661.32
|
Rate for Payer: Molina Healthcare of OH Medicare |
$6,370.02
|
|