|
UPR/L XTREMITY ART 2 LEVELS(T
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
921T0004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$542.40 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.70
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$468.95
|
| Rate for Payer: First Health Commercial |
$536.75
|
| Rate for Payer: Humana Commercial |
$480.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.20
|
| Rate for Payer: Ohio Health Group HMO |
$423.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.15
|
| Rate for Payer: PHCS Commercial |
$542.40
|
| Rate for Payer: United Healthcare All Payer |
$497.20
|
|
|
UR ALBUMIN CREATININE POC
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.59
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
UR ALBUMIN CREATININE POC
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Humana KY Medicaid |
$6.23
|
| Rate for Payer: Humana Medicare Advantage |
$6.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
UR ALBUMIN CREATININE POC
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$6.52
|
| Rate for Payer: Healthspan PPO |
$4.79
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.74
|
|
|
UR ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$6.52
|
| Rate for Payer: Healthspan PPO |
$4.79
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.80
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.74
|
|
|
UR ALBUMIN SEMIQUANTITATIVE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$6.23
|
| Rate for Payer: Humana Medicare Advantage |
$6.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
UR ALBUMIN SEMIQUANTITATIVE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
UREA 15GM PACKET
|
Facility
|
IP
|
$11.63
|
|
|
Service Code
|
NDC 62530000011
|
| Hospital Charge Code |
25004263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$11.16 |
| Rate for Payer: Aetna Commercial |
$8.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.07
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna Commercial |
$9.65
|
| Rate for Payer: First Health Commercial |
$11.05
|
| Rate for Payer: Humana Commercial |
$9.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.23
|
| Rate for Payer: Ohio Health Group HMO |
$8.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.61
|
| Rate for Payer: PHCS Commercial |
$11.16
|
| Rate for Payer: United Healthcare All Payer |
$10.23
|
|
|
UREA 15GM PACKET
|
Facility
|
OP
|
$11.63
|
|
|
Service Code
|
NDC 62530000011
|
| Hospital Charge Code |
25004263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$11.16 |
| Rate for Payer: Aetna Commercial |
$8.96
|
| Rate for Payer: Anthem Medicaid |
$4.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.07
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna Commercial |
$9.65
|
| Rate for Payer: First Health Commercial |
$11.05
|
| Rate for Payer: Humana Commercial |
$9.89
|
| Rate for Payer: Humana KY Medicaid |
$4.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.23
|
| Rate for Payer: Ohio Health Group HMO |
$8.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.61
|
| Rate for Payer: PHCS Commercial |
$11.16
|
| Rate for Payer: United Healthcare All Payer |
$10.23
|
|
|
UREA 40% CRM (198GM)
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
NDC 44523061707
|
| Hospital Charge Code |
25003551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.29
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna Commercial |
$1.38
|
| Rate for Payer: First Health Commercial |
$1.58
|
| Rate for Payer: Humana Commercial |
$1.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.46
|
| Rate for Payer: Ohio Health Group HMO |
$1.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.51
|
| Rate for Payer: PHCS Commercial |
$1.59
|
| Rate for Payer: United Healthcare All Payer |
$1.46
|
|
|
UREA 40% CRM (198GM)
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 44523061707
|
| Hospital Charge Code |
25003551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Anthem Medicaid |
$0.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.29
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna Commercial |
$1.38
|
| Rate for Payer: First Health Commercial |
$1.58
|
| Rate for Payer: Humana Commercial |
$1.41
|
| Rate for Payer: Humana KY Medicaid |
$0.57
|
| Rate for Payer: Kentucky WC Medicaid |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.46
|
| Rate for Payer: Ohio Health Group HMO |
$1.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.51
|
| Rate for Payer: PHCS Commercial |
$1.59
|
| Rate for Payer: United Healthcare All Payer |
$1.46
|
|
|
UREA NITROGEN CLEARANCE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 84545
|
| Hospital Charge Code |
30000549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
UREA NITROGEN CLEARANCE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 84545
|
| Hospital Charge Code |
30000549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$7.20
|
| Rate for Payer: Humana Medicare Advantage |
$7.20
|
| Rate for Payer: Kentucky WC Medicaid |
$7.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
UREAPLASMA CULTURE
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
30001282
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
UREAPLASMA CULTURE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
30001282
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$13.67
|
| Rate for Payer: Healthspan PPO |
$16.13
|
| Rate for Payer: Multiplan PHCS |
$98.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.80
|
| Rate for Payer: UHCCP Medicaid |
$57.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.23
|
|
|
UREAPLASMA CULTURE
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
30001282
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$15.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.39
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$15.39
|
| Rate for Payer: Humana Medicare Advantage |
$15.39
|
| Rate for Payer: Kentucky WC Medicaid |
$15.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
URECHOLINE(BETHANECH 10MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 832051100
|
| Hospital Charge Code |
25001631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
URECHOLINE(BETHANECH 10MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 832051100
|
| Hospital Charge Code |
25001631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
URECHOLINE(BETHANECH 25MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 832051200
|
| Hospital Charge Code |
25001632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
|
|
URECHOLINE(BETHANECH 25MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 832051200
|
| Hospital Charge Code |
25001632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
URETERSCOPE FLEX DISPOSABLE
|
Facility
|
IP
|
$5,192.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.02 |
| Max. Negotiated Rate |
$4,984.80 |
| Rate for Payer: Aetna Commercial |
$3,998.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,050.15
|
| Rate for Payer: Cash Price |
$2,596.25
|
| Rate for Payer: Cigna Commercial |
$4,309.78
|
| Rate for Payer: First Health Commercial |
$4,932.88
|
| Rate for Payer: Humana Commercial |
$4,413.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,832.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,569.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.68
|
| Rate for Payer: PHCS Commercial |
$4,984.80
|
| Rate for Payer: United Healthcare All Payer |
$4,569.40
|
|
|
URETERSCOPE FLEX DISPOSABLE
|
Facility
|
OP
|
$5,192.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.02 |
| Max. Negotiated Rate |
$4,984.80 |
| Rate for Payer: Aetna Commercial |
$3,998.22
|
| Rate for Payer: Anthem Medicaid |
$1,785.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,050.15
|
| Rate for Payer: Cash Price |
$2,596.25
|
| Rate for Payer: Cigna Commercial |
$4,309.78
|
| Rate for Payer: First Health Commercial |
$4,932.88
|
| Rate for Payer: Humana Commercial |
$4,413.62
|
| Rate for Payer: Humana KY Medicaid |
$1,785.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,832.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,569.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.68
|
| Rate for Payer: PHCS Commercial |
$4,984.80
|
| Rate for Payer: United Healthcare All Payer |
$4,569.40
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$20,026.16
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$13,589.18 |
| Max. Negotiated Rate |
$20,026.16 |
| Rate for Payer: Anthem Medicaid |
$13,589.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,304.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,026.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,310.94
|
| Rate for Payer: Humana KY Medicaid |
$13,589.18
|
| Rate for Payer: Humana Medicare Advantage |
$14,304.40
|
| Rate for Payer: Kentucky WC Medicaid |
$13,725.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,165.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,860.96
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$10,967.05
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$7,441.93 |
| Max. Negotiated Rate |
$10,967.05 |
| Rate for Payer: Anthem Medicaid |
$7,441.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,833.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,967.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,575.37
|
| Rate for Payer: Humana KY Medicaid |
$7,441.93
|
| Rate for Payer: Humana Medicare Advantage |
$7,833.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,516.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,400.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,590.77
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$13,021.29
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$8,835.87 |
| Max. Negotiated Rate |
$13,021.29 |
| Rate for Payer: Anthem Medicaid |
$8,835.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,300.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,021.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,556.24
|
| Rate for Payer: Humana KY Medicaid |
$8,835.87
|
| Rate for Payer: Humana Medicare Advantage |
$9,300.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,924.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,161.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,012.59
|
|
