|
MAILMAN 182CM
|
Facility
|
OP
|
$1,123.91
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$1,078.95 |
| Rate for Payer: Aetna Commercial |
$865.41
|
| Rate for Payer: Anthem Medicaid |
$386.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.65
|
| Rate for Payer: Cash Price |
$561.96
|
| Rate for Payer: Cigna Commercial |
$932.85
|
| Rate for Payer: First Health Commercial |
$1,067.71
|
| Rate for Payer: Humana Commercial |
$955.32
|
| Rate for Payer: Humana KY Medicaid |
$386.51
|
| Rate for Payer: Kentucky WC Medicaid |
$390.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.04
|
| Rate for Payer: Ohio Health Group HMO |
$842.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.41
|
| Rate for Payer: PHCS Commercial |
$1,078.95
|
| Rate for Payer: United Healthcare All Payer |
$989.04
|
|
|
MAINT OF WAKEFULNESS (MWT)
|
Facility
|
IP
|
$1,477.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$192.01 |
| Max. Negotiated Rate |
$1,417.92 |
| Rate for Payer: Aetna Commercial |
$1,137.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,152.06
|
| Rate for Payer: Cash Price |
$738.50
|
| Rate for Payer: Cigna Commercial |
$1,225.91
|
| Rate for Payer: First Health Commercial |
$1,403.15
|
| Rate for Payer: Humana Commercial |
$1,255.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,211.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,090.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$443.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,299.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,107.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.87
|
| Rate for Payer: PHCS Commercial |
$1,417.92
|
| Rate for Payer: United Healthcare All Payer |
$1,299.76
|
|
|
MAINT OF WAKEFULNESS (MWT)
|
Professional
|
Both
|
$1,477.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$73.98 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Anthem Medicaid |
$213.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,477.00
|
| Rate for Payer: Cash Price |
$738.50
|
| Rate for Payer: Cash Price |
$738.50
|
| Rate for Payer: Cigna Commercial |
$959.14
|
| Rate for Payer: Healthspan PPO |
$560.73
|
| Rate for Payer: Humana Medicaid |
$213.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.17
|
| Rate for Payer: Molina Healthcare Passport |
$213.89
|
| Rate for Payer: Multiplan PHCS |
$886.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,033.90
|
| Rate for Payer: UHCCP Medicaid |
$516.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.03
|
|
|
MAINT OF WAKEFULNESS (MWT)
|
Facility
|
OP
|
$1,477.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$192.01 |
| Max. Negotiated Rate |
$1,417.92 |
| Rate for Payer: Aetna Commercial |
$1,137.29
|
| Rate for Payer: Anthem Medicaid |
$507.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,152.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$738.50
|
| Rate for Payer: Cash Price |
$738.50
|
| Rate for Payer: Cigna Commercial |
$1,225.91
|
| Rate for Payer: First Health Commercial |
$1,403.15
|
| Rate for Payer: Humana Commercial |
$1,255.45
|
| Rate for Payer: Humana KY Medicaid |
$507.94
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$513.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,211.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,090.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$518.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,299.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,107.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.87
|
| Rate for Payer: PHCS Commercial |
$1,417.92
|
| Rate for Payer: United Healthcare All Payer |
$1,299.76
|
|
|
MAINT OF WAKEFULNESS (MWT)(P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740P0001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$959.14 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Anthem Medicaid |
$213.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$959.14
|
| Rate for Payer: Healthspan PPO |
$560.73
|
| Rate for Payer: Humana Medicaid |
$213.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.17
|
| Rate for Payer: Molina Healthcare Passport |
$213.89
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.03
|
|
|
MAINT OF WAKEFULNESS (MWT)(T
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740T0001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$167.96 |
| Max. Negotiated Rate |
$1,240.32 |
| Rate for Payer: Aetna Commercial |
$994.84
|
| Rate for Payer: Anthem Medicaid |
$444.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,007.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: First Health Commercial |
$1,227.40
|
| Rate for Payer: Humana Commercial |
$1,098.20
|
| Rate for Payer: Humana KY Medicaid |
$444.32
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$448.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.96
|
| Rate for Payer: Ohio Health Group HMO |
$969.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.52
|
| Rate for Payer: PHCS Commercial |
$1,240.32
|
| Rate for Payer: United Healthcare All Payer |
$1,136.96
|
|
|
MAINT OF WAKEFULNESS (MWT)(T
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740T0001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$167.96 |
| Max. Negotiated Rate |
$1,240.32 |
| Rate for Payer: Aetna Commercial |
$994.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,007.76
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: First Health Commercial |
$1,227.40
|
| Rate for Payer: Humana Commercial |
$1,098.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,059.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$953.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.96
|
| Rate for Payer: Ohio Health Group HMO |
$969.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.52
|
| Rate for Payer: PHCS Commercial |
$1,240.32
|
| Rate for Payer: United Healthcare All Payer |
$1,136.96
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$32,023.84
|
|
|
Service Code
|
MSDRG 654
|
| Min. Negotiated Rate |
$21,730.46 |
| Max. Negotiated Rate |
$32,023.84 |
| Rate for Payer: Anthem Medicaid |
$21,730.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,874.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,023.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,880.13
|
| Rate for Payer: Humana KY Medicaid |
$21,730.46
|
| Rate for Payer: Humana Medicare Advantage |
$22,874.17
|
| Rate for Payer: Kentucky WC Medicaid |
$21,947.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,449.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,165.07
|
|
|
MAJOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,329.41
|
|
|
Service Code
|
MSDRG 653
|
| Min. Negotiated Rate |
$42,973.53 |
| Max. Negotiated Rate |
$63,329.41 |
| Rate for Payer: Anthem Medicaid |
$42,973.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$45,235.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$63,329.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$61,067.64
|
| Rate for Payer: Humana KY Medicaid |
$42,973.53
|
| Rate for Payer: Humana Medicare Advantage |
$45,235.29
|
| Rate for Payer: Kentucky WC Medicaid |
$43,403.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54,282.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,833.00
|
|
|
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,657.46
|
|
|
Service Code
|
MSDRG 655
|
| Min. Negotiated Rate |
$16,731.85 |
| Max. Negotiated Rate |
$24,657.46 |
| Rate for Payer: Anthem Medicaid |
$16,731.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,612.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,657.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,776.83
|
| Rate for Payer: Humana KY Medicaid |
$16,731.85
|
| Rate for Payer: Humana Medicare Advantage |
$17,612.47
|
| Rate for Payer: Kentucky WC Medicaid |
$16,899.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,134.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,066.48
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$29,835.11
|
|
|
Service Code
|
MSDRG 164
|
| Min. Negotiated Rate |
$20,245.25 |
| Max. Negotiated Rate |
$29,835.11 |
| Rate for Payer: Anthem Medicaid |
$20,245.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21,310.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,835.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$28,769.57
|
| Rate for Payer: Humana KY Medicaid |
$20,245.25
|
| Rate for Payer: Humana Medicare Advantage |
$21,310.79
|
| Rate for Payer: Kentucky WC Medicaid |
$20,447.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,572.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,650.16
|
|
|
MAJOR CHEST PROCEDURES WITH MCC
|
Facility
|
IP
|
$55,140.65
|
|
|
Service Code
|
MSDRG 163
|
| Min. Negotiated Rate |
$37,416.87 |
| Max. Negotiated Rate |
$55,140.65 |
| Rate for Payer: Anthem Medicaid |
$37,416.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39,386.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55,140.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$53,171.34
|
| Rate for Payer: Humana KY Medicaid |
$37,416.87
|
| Rate for Payer: Humana Medicare Advantage |
$39,386.18
|
| Rate for Payer: Kentucky WC Medicaid |
$37,791.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47,263.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,165.21
|
|
|
MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,950.52
|
|
|
Service Code
|
MSDRG 165
|
| Min. Negotiated Rate |
$14,894.99 |
| Max. Negotiated Rate |
$21,950.52 |
| Rate for Payer: Anthem Medicaid |
$14,894.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,678.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,950.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,166.57
|
| Rate for Payer: Humana KY Medicaid |
$14,894.99
|
| Rate for Payer: Humana Medicare Advantage |
$15,678.94
|
| Rate for Payer: Kentucky WC Medicaid |
$15,043.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,814.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,192.89
|
|
|
MAJOR CHEST TRAUMA WITH CC
|
Facility
|
IP
|
$12,305.33
|
|
|
Service Code
|
MSDRG 184
|
| Min. Negotiated Rate |
$8,350.04 |
| Max. Negotiated Rate |
$12,305.33 |
| Rate for Payer: Anthem Medicaid |
$8,350.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,789.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,305.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,865.85
|
| Rate for Payer: Humana KY Medicaid |
$8,350.04
|
| Rate for Payer: Humana Medicare Advantage |
$8,789.52
|
| Rate for Payer: Kentucky WC Medicaid |
$8,433.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,547.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,517.04
|
|
|
MAJOR CHEST TRAUMA WITH MCC
|
Facility
|
IP
|
$18,418.81
|
|
|
Service Code
|
MSDRG 183
|
| Min. Negotiated Rate |
$12,498.48 |
| Max. Negotiated Rate |
$18,418.81 |
| Rate for Payer: Anthem Medicaid |
$12,498.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,156.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,418.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,760.99
|
| Rate for Payer: Humana KY Medicaid |
$12,498.48
|
| Rate for Payer: Humana Medicare Advantage |
$13,156.29
|
| Rate for Payer: Kentucky WC Medicaid |
$12,623.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,787.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,748.45
|
|
|
MAJOR CHEST TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$8,840.33
|
|
|
Service Code
|
MSDRG 185
|
| Min. Negotiated Rate |
$5,998.79 |
| Max. Negotiated Rate |
$8,840.33 |
| Rate for Payer: Anthem Medicaid |
$5,998.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,314.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,840.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,524.60
|
| Rate for Payer: Humana KY Medicaid |
$5,998.79
|
| Rate for Payer: Humana Medicare Advantage |
$6,314.52
|
| Rate for Payer: Kentucky WC Medicaid |
$6,058.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,577.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,118.77
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH CC
|
Facility
|
IP
|
$11,561.34
|
|
|
Service Code
|
MSDRG 369
|
| Min. Negotiated Rate |
$7,845.20 |
| Max. Negotiated Rate |
$11,561.34 |
| Rate for Payer: Anthem Medicaid |
$7,845.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,258.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,561.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,148.44
|
| Rate for Payer: Humana KY Medicaid |
$7,845.20
|
| Rate for Payer: Humana Medicare Advantage |
$8,258.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,923.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,002.10
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH MCC
|
Facility
|
IP
|
$19,325.43
|
|
|
Service Code
|
MSDRG 368
|
| Min. Negotiated Rate |
$13,113.69 |
| Max. Negotiated Rate |
$19,325.43 |
| Rate for Payer: Anthem Medicaid |
$13,113.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,803.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,325.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,635.24
|
| Rate for Payer: Humana KY Medicaid |
$13,113.69
|
| Rate for Payer: Humana Medicare Advantage |
$13,803.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13,244.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,564.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,375.96
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,699.96
|
|
|
Service Code
|
MSDRG 370
|
| Min. Negotiated Rate |
$5,903.55 |
| Max. Negotiated Rate |
$8,699.96 |
| Rate for Payer: Anthem Medicaid |
$5,903.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,214.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,699.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,389.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.55
|
| Rate for Payer: Humana Medicare Advantage |
$6,214.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,962.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,457.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.62
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC
|
Facility
|
IP
|
$12,193.03
|
|
|
Service Code
|
MSDRG 372
|
| Min. Negotiated Rate |
$8,273.84 |
| Max. Negotiated Rate |
$12,193.03 |
| Rate for Payer: Anthem Medicaid |
$8,273.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,709.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,193.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,757.57
|
| Rate for Payer: Humana KY Medicaid |
$8,273.84
|
| Rate for Payer: Humana Medicare Advantage |
$8,709.31
|
| Rate for Payer: Kentucky WC Medicaid |
$8,356.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,451.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,439.32
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC
|
Facility
|
IP
|
$20,444.96
|
|
|
Service Code
|
MSDRG 371
|
| Min. Negotiated Rate |
$13,873.36 |
| Max. Negotiated Rate |
$20,444.96 |
| Rate for Payer: Anthem Medicaid |
$13,873.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,603.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,444.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,714.78
|
| Rate for Payer: Humana KY Medicaid |
$13,873.36
|
| Rate for Payer: Humana Medicare Advantage |
$14,603.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,012.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,524.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,150.83
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,381.77
|
|
|
Service Code
|
MSDRG 373
|
| Min. Negotiated Rate |
$5,687.63 |
| Max. Negotiated Rate |
$8,381.77 |
| Rate for Payer: Anthem Medicaid |
$5,687.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,986.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,381.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,082.42
|
| Rate for Payer: Humana KY Medicaid |
$5,687.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,986.98
|
| Rate for Payer: Kentucky WC Medicaid |
$5,744.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,184.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,801.38
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
|
IP
|
$24,235.16
|
|
|
Service Code
|
MSDRG 141
|
| Min. Negotiated Rate |
$16,445.29 |
| Max. Negotiated Rate |
$24,235.16 |
| Rate for Payer: Anthem Medicaid |
$16,445.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,310.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,235.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,369.62
|
| Rate for Payer: Humana KY Medicaid |
$16,445.29
|
| Rate for Payer: Humana Medicare Advantage |
$17,310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$16,609.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,773.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,774.19
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
|
IP
|
$44,196.99
|
|
|
Service Code
|
MSDRG 140
|
| Min. Negotiated Rate |
$29,990.82 |
| Max. Negotiated Rate |
$44,196.99 |
| Rate for Payer: Anthem Medicaid |
$29,990.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31,569.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$44,196.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$42,618.53
|
| Rate for Payer: Humana KY Medicaid |
$29,990.82
|
| Rate for Payer: Humana Medicare Advantage |
$31,569.28
|
| Rate for Payer: Kentucky WC Medicaid |
$30,290.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,883.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,590.63
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,073.73
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$12,264.32 |
| Max. Negotiated Rate |
$18,073.73 |
| Rate for Payer: Anthem Medicaid |
$12,264.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,909.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,073.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,428.24
|
| Rate for Payer: Humana KY Medicaid |
$12,264.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,909.81
|
| Rate for Payer: Kentucky WC Medicaid |
$12,386.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,491.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,509.61
|
|
