|
OS YEAST IDENTIFICATION EACH
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
30001277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS YEAST IDENTIFICATION EACH
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
30001277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS ZINC BLOOD
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
30000558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS ZINC BLOOD
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
30000558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$11.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.39
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$11.39
|
| Rate for Payer: Humana Medicare Advantage |
$11.39
|
| Rate for Payer: Kentucky WC Medicaid |
$11.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
OS ZINC PROTOPORPHYRINS
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 84202
|
| Hospital Charge Code |
30000502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS ZINC PROTOPORPHYRINS
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 84202
|
| Hospital Charge Code |
30000502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$14.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$14.35
|
| Rate for Payer: Humana Medicare Advantage |
$14.35
|
| Rate for Payer: Kentucky WC Medicaid |
$14.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
OS ZONISAMIDE S
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
30000053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
OS ZONISAMIDE S
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
30000053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
OT ADL/SELF CARE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OT ADL/SELF CARE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$35.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$35.08
|
| Rate for Payer: Kentucky WC Medicaid |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
OT COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
43000025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OT COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
43000025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
OT EVAL HIGH
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 97167
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
OT EVAL HIGH
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 97167
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem Medicaid |
$107.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Humana KY Medicaid |
$107.64
|
| Rate for Payer: Kentucky WC Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
OT EVAL LOW
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 97165
|
| Hospital Charge Code |
43000019
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
OT EVAL LOW
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 97165
|
| Hospital Charge Code |
43000019
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
OT EVAL MOD
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 97166
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem Medicaid |
$103.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.56
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Humana KY Medicaid |
$103.86
|
| Rate for Payer: Kentucky WC Medicaid |
$104.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.62
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
OT EVAL MOD
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 97166
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.56
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.62
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$16,741.30
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$11,360.17 |
| Max. Negotiated Rate |
$16,741.30 |
| Rate for Payer: Anthem Medicaid |
$11,360.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,958.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,741.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,143.39
|
| Rate for Payer: Humana KY Medicaid |
$11,360.17
|
| Rate for Payer: Humana Medicare Advantage |
$11,958.07
|
| Rate for Payer: Kentucky WC Medicaid |
$11,473.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,587.37
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$32,951.49
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$22,359.94 |
| Max. Negotiated Rate |
$32,951.49 |
| Rate for Payer: Anthem Medicaid |
$22,359.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,536.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,951.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$31,774.65
|
| Rate for Payer: Humana KY Medicaid |
$22,359.94
|
| Rate for Payer: Humana Medicare Advantage |
$23,536.78
|
| Rate for Payer: Kentucky WC Medicaid |
$22,583.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,244.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,807.14
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$10,612.60
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$7,201.41 |
| Max. Negotiated Rate |
$10,612.60 |
| Rate for Payer: Anthem Medicaid |
$7,201.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,580.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,612.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,233.58
|
| Rate for Payer: Humana KY Medicaid |
$7,201.41
|
| Rate for Payer: Humana Medicare Advantage |
$7,580.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,273.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,345.44
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$8,629.75
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$5,855.90 |
| Max. Negotiated Rate |
$8,629.75 |
| Rate for Payer: Anthem Medicaid |
$5,855.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,164.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,629.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,321.55
|
| Rate for Payer: Humana KY Medicaid |
$5,855.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,164.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,914.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,396.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,973.02
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$12,579.08
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$8,535.81 |
| Max. Negotiated Rate |
$12,579.08 |
| Rate for Payer: Anthem Medicaid |
$8,535.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,985.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,579.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,129.83
|
| Rate for Payer: Humana KY Medicaid |
$8,535.81
|
| Rate for Payer: Humana Medicare Advantage |
$8,985.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,621.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,782.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,706.52
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$5,987.13
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$4,062.69 |
| Max. Negotiated Rate |
$5,987.13 |
| Rate for Payer: Anthem Medicaid |
$4,062.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,276.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5,987.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,773.30
|
| Rate for Payer: Humana KY Medicaid |
$4,062.69
|
| Rate for Payer: Humana Medicare Advantage |
$4,276.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,131.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.95
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$58,943.75
|
|
|
Service Code
|
MSDRG 228
|
| Min. Negotiated Rate |
$39,997.55 |
| Max. Negotiated Rate |
$58,943.75 |
| Rate for Payer: Anthem Medicaid |
$39,997.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42,102.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58,943.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$56,838.62
|
| Rate for Payer: Humana KY Medicaid |
$39,997.55
|
| Rate for Payer: Humana Medicare Advantage |
$42,102.68
|
| Rate for Payer: Kentucky WC Medicaid |
$40,397.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50,523.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,797.50
|
|
