|
ORENCIA 10MG(ABATACEPT)250MG V
|
Facility
|
IP
|
$7,970.52
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
25001820
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,036.17 |
| Max. Negotiated Rate |
$7,651.70 |
| Rate for Payer: Aetna Commercial |
$6,137.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.01
|
| Rate for Payer: Cash Price |
$3,985.26
|
| Rate for Payer: Cigna Commercial |
$6,615.53
|
| Rate for Payer: First Health Commercial |
$7,571.99
|
| Rate for Payer: Humana Commercial |
$6,774.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,535.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,977.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,470.86
|
| Rate for Payer: PHCS Commercial |
$7,651.70
|
| Rate for Payer: United Healthcare All Payer |
$7,014.06
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$20,552.59
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$13,946.40 |
| Max. Negotiated Rate |
$20,552.59 |
| Rate for Payer: Anthem Medicaid |
$13,946.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,680.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,552.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,818.57
|
| Rate for Payer: Humana KY Medicaid |
$13,946.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,680.42
|
| Rate for Payer: Kentucky WC Medicaid |
$14,085.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,616.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,225.33
|
|
|
ORIF W/INTRA BIP MM CU 4TH MET
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.10
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
ORIF W/INTRA BIP MM CU 4TH MET
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$285.50 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$32.67
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
ORIF W/INTRA BIP MM CU 4TH MET
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
OR LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
36001081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OR LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
36001081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OR LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$2,734.00
|
|
| Hospital Charge Code |
36001082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
OR LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$2,734.00
|
|
| Hospital Charge Code |
36001082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem Medicaid |
$940.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Humana KY Medicaid |
$940.22
|
| Rate for Payer: Kentucky WC Medicaid |
$949.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$959.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
OR LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$3,989.00
|
|
| Hospital Charge Code |
36001083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
OR LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$3,989.00
|
|
| Hospital Charge Code |
36001083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem Medicaid |
$1,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Humana KY Medicaid |
$1,371.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
OR LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
36001084
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
OR LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
36001084
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem Medicaid |
$1,465.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Humana KY Medicaid |
$1,465.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
OR LEVEL 5 PER 15 MIN
|
Facility
|
OP
|
$7,097.00
|
|
| Hospital Charge Code |
36001085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem Medicaid |
$2,440.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Humana KY Medicaid |
$2,440.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,129.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
OR LEVEL 5 PER 15 MIN
|
Facility
|
IP
|
$7,097.00
|
|
| Hospital Charge Code |
36001085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,129.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$18,976.85
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$12,877.15 |
| Max. Negotiated Rate |
$18,976.85 |
| Rate for Payer: Anthem Medicaid |
$12,877.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,554.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,976.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,299.10
|
| Rate for Payer: Humana KY Medicaid |
$12,877.15
|
| Rate for Payer: Humana Medicare Advantage |
$13,554.89
|
| Rate for Payer: Kentucky WC Medicaid |
$13,005.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,265.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,134.69
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$30,444.60
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$20,658.83 |
| Max. Negotiated Rate |
$30,444.60 |
| Rate for Payer: Anthem Medicaid |
$20,658.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21,746.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30,444.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$29,357.29
|
| Rate for Payer: Humana KY Medicaid |
$20,658.83
|
| Rate for Payer: Humana Medicare Advantage |
$21,746.14
|
| Rate for Payer: Kentucky WC Medicaid |
$20,865.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,095.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,072.01
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$17,749.68
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$12,044.42 |
| Max. Negotiated Rate |
$17,749.68 |
| Rate for Payer: Anthem Medicaid |
$12,044.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,678.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,749.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,115.76
|
| Rate for Payer: Humana KY Medicaid |
$12,044.42
|
| Rate for Payer: Humana Medicare Advantage |
$12,678.34
|
| Rate for Payer: Kentucky WC Medicaid |
$12,164.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,214.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,285.31
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$25,345.32
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$17,198.61 |
| Max. Negotiated Rate |
$25,345.32 |
| Rate for Payer: Anthem Medicaid |
$17,198.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,103.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,345.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,440.13
|
| Rate for Payer: Humana KY Medicaid |
$17,198.61
|
| Rate for Payer: Humana Medicare Advantage |
$18,103.80
|
| Rate for Payer: Kentucky WC Medicaid |
$17,370.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,724.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,542.58
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$37,613.24
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$25,523.27 |
| Max. Negotiated Rate |
$37,613.24 |
| Rate for Payer: Anthem Medicaid |
$25,523.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26,866.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,613.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,269.91
|
| Rate for Payer: Humana KY Medicaid |
$25,523.27
|
| Rate for Payer: Humana Medicare Advantage |
$26,866.60
|
| Rate for Payer: Kentucky WC Medicaid |
$25,778.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,239.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,033.74
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,711.86
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$14,733.05 |
| Max. Negotiated Rate |
$21,711.86 |
| Rate for Payer: Anthem Medicaid |
$14,733.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,508.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,711.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,936.43
|
| Rate for Payer: Humana KY Medicaid |
$14,733.05
|
| Rate for Payer: Humana Medicare Advantage |
$15,508.47
|
| Rate for Payer: Kentucky WC Medicaid |
$14,880.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,610.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,027.71
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$43,651.85
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$29,620.90 |
| Max. Negotiated Rate |
$43,651.85 |
| Rate for Payer: Anthem Medicaid |
$29,620.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31,179.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43,651.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$42,092.85
|
| Rate for Payer: Humana KY Medicaid |
$29,620.90
|
| Rate for Payer: Humana Medicare Advantage |
$31,179.89
|
| Rate for Payer: Kentucky WC Medicaid |
$29,917.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,415.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,213.31
|
|
|
ORTHO/PROSMAN +/-TRAINSUB15MIN
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
43000033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ORTHO/PROSMAN +/-TRAINSUB15MIN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
43000033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ORTHOTIC FIT/TRAINING 15 MIN
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
43000031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
