|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$23,877.21
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$16,202.39 |
| Max. Negotiated Rate |
$23,877.21 |
| Rate for Payer: Anthem Medicaid |
$16,202.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,055.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,877.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,024.45
|
| Rate for Payer: Humana KY Medicaid |
$16,202.39
|
| Rate for Payer: Humana Medicare Advantage |
$17,055.15
|
| Rate for Payer: Kentucky WC Medicaid |
$16,364.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,466.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,526.44
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$19,851.86
|
|
|
Service Code
|
MSDRG 988
|
| Min. Negotiated Rate |
$13,470.90 |
| Max. Negotiated Rate |
$19,851.86 |
| Rate for Payer: Anthem Medicaid |
$13,470.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,179.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,851.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,142.86
|
| Rate for Payer: Humana KY Medicaid |
$13,470.90
|
| Rate for Payer: Humana Medicare Advantage |
$14,179.90
|
| Rate for Payer: Kentucky WC Medicaid |
$13,605.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,015.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,740.32
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$39,501.34
|
|
|
Service Code
|
MSDRG 987
|
| Min. Negotiated Rate |
$26,804.48 |
| Max. Negotiated Rate |
$39,501.34 |
| Rate for Payer: Anthem Medicaid |
$26,804.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,215.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,501.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,090.57
|
| Rate for Payer: Humana KY Medicaid |
$26,804.48
|
| Rate for Payer: Humana Medicare Advantage |
$28,215.24
|
| Rate for Payer: Kentucky WC Medicaid |
$27,072.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,858.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,340.57
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,637.58
|
|
|
Service Code
|
MSDRG 989
|
| Min. Negotiated Rate |
$8,575.50 |
| Max. Negotiated Rate |
$12,637.58 |
| Rate for Payer: Anthem Medicaid |
$8,575.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,026.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,637.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,186.23
|
| Rate for Payer: Humana KY Medicaid |
$8,575.50
|
| Rate for Payer: Humana Medicare Advantage |
$9,026.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,661.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,832.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,747.01
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$155.01
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Healthspan PPO |
$147.18
|
| Rate for Payer: Humana Medicaid |
$87.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.40
|
| Rate for Payer: Molina Healthcare Passport |
$87.65
|
| Rate for Payer: Multiplan PHCS |
$102.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.70
|
| Rate for Payer: UHCCP Medicaid |
$59.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.59
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$87.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$87.65
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$88.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
NON-LOCKING SCREWS 3.5*22MM
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem Medicaid |
$594.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Humana KY Medicaid |
$594.26
|
| Rate for Payer: Kentucky WC Medicaid |
$600.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
NON-LOCKING SCREWS 3.5*22MM
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$11,996.50
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$8,140.48 |
| Max. Negotiated Rate |
$11,996.50 |
| Rate for Payer: Anthem Medicaid |
$8,140.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,568.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,996.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,568.06
|
| Rate for Payer: Humana KY Medicaid |
$8,140.48
|
| Rate for Payer: Humana Medicare Advantage |
$8,568.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,221.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,282.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,303.29
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$7,410.82
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$5,028.77 |
| Max. Negotiated Rate |
$7,410.82 |
| Rate for Payer: Anthem Medicaid |
$5,028.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,293.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,410.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,146.14
|
| Rate for Payer: Humana KY Medicaid |
$5,028.77
|
| Rate for Payer: Humana Medicare Advantage |
$5,293.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,079.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,129.34
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
OP
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.87 |
| Max. Negotiated Rate |
$3,329.50 |
| Rate for Payer: Aetna Commercial |
$2,670.54
|
| Rate for Payer: Anthem Medicaid |
$1,192.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.22
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$2,878.63
|
| Rate for Payer: First Health Commercial |
$3,294.82
|
| Rate for Payer: Humana Commercial |
$2,948.00
|
| Rate for Payer: Humana KY Medicaid |
$1,192.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,204.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,843.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.15
|
| Rate for Payer: PHCS Commercial |
$3,329.50
|
| Rate for Payer: United Healthcare All Payer |
$3,052.04
|
|
|
NON SEL CATH AORTA CATH
|
Professional
|
Both
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$3,468.23 |
| Rate for Payer: Aetna Commercial |
$268.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.60
|
| Rate for Payer: Anthem Medicaid |
$168.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,468.23
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$249.28
|
| Rate for Payer: Healthspan PPO |
$1,011.52
|
| Rate for Payer: Humana Medicaid |
$168.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.01
|
| Rate for Payer: Molina Healthcare Passport |
$168.64
|
| Rate for Payer: Multiplan PHCS |
$2,080.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,427.76
|
| Rate for Payer: UHCCP Medicaid |
$114.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.33
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
IP
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.87 |
| Max. Negotiated Rate |
$3,329.50 |
| Rate for Payer: Aetna Commercial |
$2,670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.22
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$2,878.63
|
| Rate for Payer: First Health Commercial |
$3,294.82
|
| Rate for Payer: Humana Commercial |
$2,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,843.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.15
|
| Rate for Payer: PHCS Commercial |
$3,329.50
|
| Rate for Payer: United Healthcare All Payer |
$3,052.04
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
48100010
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.89 |
| Max. Negotiated Rate |
$2,738.88 |
| Rate for Payer: Aetna Commercial |
$2,196.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,225.34
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna Commercial |
$2,367.99
|
| Rate for Payer: First Health Commercial |
$2,710.35
|
| Rate for Payer: Humana Commercial |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,339.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,105.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,510.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,139.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$884.43
|
| Rate for Payer: PHCS Commercial |
$2,738.88
|
| Rate for Payer: United Healthcare All Payer |
$2,510.64
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
48100010
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.89 |
| Max. Negotiated Rate |
$2,738.88 |
| Rate for Payer: Aetna Commercial |
$2,196.81
|
| Rate for Payer: Anthem Medicaid |
$981.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,225.34
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna Commercial |
$2,367.99
|
| Rate for Payer: First Health Commercial |
$2,710.35
|
| Rate for Payer: Humana Commercial |
$2,425.05
|
| Rate for Payer: Humana KY Medicaid |
$981.15
|
| Rate for Payer: Kentucky WC Medicaid |
$991.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,339.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,105.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,510.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,139.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$884.43
|
| Rate for Payer: PHCS Commercial |
$2,738.88
|
| Rate for Payer: United Healthcare All Payer |
$2,510.64
|
|
|
NON SEL CATH AORTA CATH(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761P1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$1,011.52 |
| Rate for Payer: Aetna Commercial |
$268.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.60
|
| Rate for Payer: Anthem Medicaid |
$168.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$249.28
|
| Rate for Payer: Healthspan PPO |
$1,011.52
|
| Rate for Payer: Humana Medicaid |
$168.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.01
|
| Rate for Payer: Molina Healthcare Passport |
$168.64
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$114.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.33
|
|
|
NON SEL CATH AORTA CATH(T
|
Facility
|
IP
|
$2,568.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761T1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$2,465.50 |
| Rate for Payer: Aetna Commercial |
$1,977.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.22
|
| Rate for Payer: Cash Price |
$1,284.12
|
| Rate for Payer: Cigna Commercial |
$2,131.63
|
| Rate for Payer: First Health Commercial |
$2,439.82
|
| Rate for Payer: Humana Commercial |
$2,183.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,105.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,895.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$770.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,260.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,926.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.15
|
| Rate for Payer: PHCS Commercial |
$2,465.50
|
| Rate for Payer: United Healthcare All Payer |
$2,260.04
|
|
|
NON SEL CATH AORTA CATH(T
|
Facility
|
OP
|
$2,568.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761T1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$2,465.50 |
| Rate for Payer: Aetna Commercial |
$1,977.54
|
| Rate for Payer: Anthem Medicaid |
$883.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.22
|
| Rate for Payer: Cash Price |
$1,284.12
|
| Rate for Payer: Cigna Commercial |
$2,131.63
|
| Rate for Payer: First Health Commercial |
$2,439.82
|
| Rate for Payer: Humana Commercial |
$2,183.00
|
| Rate for Payer: Humana KY Medicaid |
$883.21
|
| Rate for Payer: Kentucky WC Medicaid |
$892.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,105.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,895.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$770.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$900.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,260.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,926.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.15
|
| Rate for Payer: PHCS Commercial |
$2,465.50
|
| Rate for Payer: United Healthcare All Payer |
$2,260.04
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$12,421.16
|
|
|
Service Code
|
MSDRG 071
|
| Min. Negotiated Rate |
$8,428.65 |
| Max. Negotiated Rate |
$12,421.16 |
| Rate for Payer: Anthem Medicaid |
$8,428.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,872.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,421.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,977.55
|
| Rate for Payer: Humana KY Medicaid |
$8,428.65
|
| Rate for Payer: Humana Medicare Advantage |
$8,872.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,512.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,646.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,597.22
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$20,933.93
|
|
|
Service Code
|
MSDRG 070
|
| Min. Negotiated Rate |
$14,205.17 |
| Max. Negotiated Rate |
$20,933.93 |
| Rate for Payer: Anthem Medicaid |
$14,205.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,952.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,933.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,186.29
|
| Rate for Payer: Humana KY Medicaid |
$14,205.17
|
| Rate for Payer: Humana Medicare Advantage |
$14,952.81
|
| Rate for Payer: Kentucky WC Medicaid |
$14,347.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,943.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,489.27
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,159.70
|
|
|
Service Code
|
MSDRG 072
|
| Min. Negotiated Rate |
$6,215.51 |
| Max. Negotiated Rate |
$9,159.70 |
| Rate for Payer: Anthem Medicaid |
$6,215.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,542.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,159.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,832.56
|
| Rate for Payer: Humana KY Medicaid |
$6,215.51
|
| Rate for Payer: Humana Medicare Advantage |
$6,542.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,277.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,851.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,339.82
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$16,575.17
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$11,247.44 |
| Max. Negotiated Rate |
$16,575.17 |
| Rate for Payer: Anthem Medicaid |
$11,247.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,839.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,575.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,983.20
|
| Rate for Payer: Humana KY Medicaid |
$11,247.44
|
| Rate for Payer: Humana Medicare Advantage |
$11,839.41
|
| Rate for Payer: Kentucky WC Medicaid |
$11,359.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,207.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,472.39
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$10,189.13
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$6,914.05 |
| Max. Negotiated Rate |
$10,189.13 |
| Rate for Payer: Anthem Medicaid |
$6,914.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,277.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,189.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,825.23
|
| Rate for Payer: Humana KY Medicaid |
$6,914.05
|
| Rate for Payer: Humana Medicare Advantage |
$7,277.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,983.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,733.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,052.33
|
|
|
NON-SURGICAL OFFICE CONSULT
|
Professional
|
Both
|
$25.00
|
|
| Hospital Charge Code |
22200117
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$25.00
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
|
