|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$11,167.11
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$7,577.68 |
| Max. Negotiated Rate |
$11,167.11 |
| Rate for Payer: Anthem Medicaid |
$7,577.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,976.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,167.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,768.29
|
| Rate for Payer: Humana KY Medicaid |
$7,577.68
|
| Rate for Payer: Humana Medicare Advantage |
$7,976.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,653.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,571.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,729.24
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$17,286.43
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$11,730.08 |
| Max. Negotiated Rate |
$17,286.43 |
| Rate for Payer: Anthem Medicaid |
$11,730.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,347.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,286.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,669.06
|
| Rate for Payer: Humana KY Medicaid |
$11,730.08
|
| Rate for Payer: Humana Medicare Advantage |
$12,347.45
|
| Rate for Payer: Kentucky WC Medicaid |
$11,847.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,816.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,964.68
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$30,333.45
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$20,583.41 |
| Max. Negotiated Rate |
$30,333.45 |
| Rate for Payer: Anthem Medicaid |
$20,583.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21,666.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30,333.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$29,250.11
|
| Rate for Payer: Humana KY Medicaid |
$20,583.41
|
| Rate for Payer: Humana Medicare Advantage |
$21,666.75
|
| Rate for Payer: Kentucky WC Medicaid |
$20,789.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,000.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,995.08
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,693.73
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$8,613.60 |
| Max. Negotiated Rate |
$12,693.73 |
| Rate for Payer: Anthem Medicaid |
$8,613.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,066.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,693.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,240.38
|
| Rate for Payer: Humana KY Medicaid |
$8,613.60
|
| Rate for Payer: Humana Medicare Advantage |
$9,066.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,699.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,880.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,785.87
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem Medicaid |
$319.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Humana KY Medicaid |
$319.83
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$444.42
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$930.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$395.43
|
| Rate for Payer: Healthspan PPO |
$444.19
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$558.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$651.00
|
| Rate for Payer: UHCCP Medicaid |
$325.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
|
|
ACUTE GI BLOOD LOSS IMAGING(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340P0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$444.42 |
| Rate for Payer: Aetna Commercial |
$444.42
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$395.43
|
| Rate for Payer: Healthspan PPO |
$444.19
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
|
|
ACUTE GI BLOOD LOSS IMAGING(T
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340T0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
ACUTE GI BLOOD LOSS IMAGING(T
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340T0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem Medicaid |
$47.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.63
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Humana KY Medicaid |
$47.63
|
| Rate for Payer: Humana Medicare Advantage |
$47.63
|
| Rate for Payer: Kentucky WC Medicaid |
$48.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.83
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.28
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.83
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
ACUTE HEPATITIS PANEL
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$96.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.00
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$47.95
|
| Rate for Payer: Healthspan PPO |
$44.97
|
| Rate for Payer: Multiplan PHCS |
$175.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.10
|
| Rate for Payer: UHCCP Medicaid |
$102.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.58
|
|
|
ACUTE INITIAL OBS PERDAY LVL 1
|
Facility
|
OP
|
$1,679.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem Medicaid |
$577.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Humana KY Medicaid |
$577.41
|
| Rate for Payer: Kentucky WC Medicaid |
$583.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$588.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
ACUTE INITIAL OBS PERDAY LVL 1
|
Facility
|
IP
|
$1,679.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
ACUTE INITIAL OBS PERDAY LVL 2
|
Facility
|
OP
|
$3,034.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$394.42 |
| Max. Negotiated Rate |
$2,912.64 |
| Rate for Payer: Aetna Commercial |
$2,336.18
|
| Rate for Payer: Anthem Medicaid |
$1,043.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.52
|
| Rate for Payer: Cash Price |
$1,517.00
|
| Rate for Payer: Cigna Commercial |
$2,518.22
|
| Rate for Payer: First Health Commercial |
$2,882.30
|
| Rate for Payer: Humana Commercial |
$2,578.90
|
| Rate for Payer: Humana KY Medicaid |
$1,043.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,239.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.54
|
| Rate for Payer: PHCS Commercial |
$2,912.64
|
| Rate for Payer: United Healthcare All Payer |
$2,669.92
|
|
|
ACUTE INITIAL OBS PERDAY LVL 2
|
Facility
|
IP
|
$3,034.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$394.42 |
| Max. Negotiated Rate |
$2,912.64 |
| Rate for Payer: Aetna Commercial |
$2,336.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.52
|
| Rate for Payer: Cash Price |
$1,517.00
|
| Rate for Payer: Cigna Commercial |
$2,518.22
|
| Rate for Payer: First Health Commercial |
$2,882.30
|
| Rate for Payer: Humana Commercial |
$2,578.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,239.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.54
|
| Rate for Payer: PHCS Commercial |
$2,912.64
|
| Rate for Payer: United Healthcare All Payer |
$2,669.92
|
|
|
ACUTE INITIAL OBS PERDAY LVL 3
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ACUTE INITIAL OBS PERDAY LVL 3
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ACUTE INTENSIVE HEMODIALYSIS
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80000001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$846.01 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem Medicaid |
$160.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.79
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Humana KY Medicaid |
$160.60
|
| Rate for Payer: Humana Medicare Advantage |
$604.29
|
| Rate for Payer: Kentucky WC Medicaid |
$162.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.77
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
ACUTE INTENSIVE HEMODIALYSIS
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80000001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.77
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$26,151.33
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$17,745.54 |
| Max. Negotiated Rate |
$26,151.33 |
| Rate for Payer: Anthem Medicaid |
$17,745.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,679.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,151.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,217.35
|
| Rate for Payer: Humana KY Medicaid |
$17,745.54
|
| Rate for Payer: Humana Medicare Advantage |
$18,679.52
|
| Rate for Payer: Kentucky WC Medicaid |
$17,923.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,415.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,100.45
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$65,498.24
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$44,445.24 |
| Max. Negotiated Rate |
$65,498.24 |
| Rate for Payer: Anthem Medicaid |
$44,445.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46,784.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65,498.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$63,159.02
|
| Rate for Payer: Humana KY Medicaid |
$44,445.24
|
| Rate for Payer: Humana Medicare Advantage |
$46,784.46
|
| Rate for Payer: Kentucky WC Medicaid |
$44,889.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56,141.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,334.14
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,516.68
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$11,207.75 |
| Max. Negotiated Rate |
$16,516.68 |
| Rate for Payer: Anthem Medicaid |
$11,207.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,797.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,516.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,926.80
|
| Rate for Payer: Humana KY Medicaid |
$11,207.75
|
| Rate for Payer: Humana Medicare Advantage |
$11,797.63
|
| Rate for Payer: Kentucky WC Medicaid |
$11,319.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,157.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,431.90
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$14,987.74
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$10,170.25 |
| Max. Negotiated Rate |
$14,987.74 |
| Rate for Payer: Anthem Medicaid |
$10,170.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,705.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,987.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,452.47
|
| Rate for Payer: Humana KY Medicaid |
$10,170.25
|
| Rate for Payer: Humana Medicare Advantage |
$10,705.53
|
| Rate for Payer: Kentucky WC Medicaid |
$10,271.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,373.66
|
|
