|
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 53450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)
|
Facility
|
OP
|
$6,264.36
|
|
|
Service Code
|
CPT 53400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,474.54 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
|
|
URIC ACID - BLOOD
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$4.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.52
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$4.52
|
| Rate for Payer: Humana Medicare Advantage |
$4.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
URIC ACID - BLOOD
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
URIC ACID - BLOOD
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna Commercial |
$10.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: Healthspan PPO |
$4.73
|
| Rate for Payer: Multiplan PHCS |
$34.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.60
|
| Rate for Payer: UHCCP Medicaid |
$20.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.71
|
|
|
URINALYSIS
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: Healthspan PPO |
$2.36
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.35
|
|
|
URINALYSIS
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$2.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$2.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
URINALYSIS
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.54
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem Medicaid |
$2.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| Rate for Payer: Humana KY Medicaid |
$2.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.54
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: Healthspan PPO |
$2.36
|
| Rate for Payer: Multiplan PHCS |
$20.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.80
|
| Rate for Payer: UHCCP Medicaid |
$11.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.35
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$16,568.16
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$11,242.68 |
| Max. Negotiated Rate |
$16,568.16 |
| Rate for Payer: Anthem Medicaid |
$11,242.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,834.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,568.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,976.44
|
| Rate for Payer: Humana KY Medicaid |
$11,242.68
|
| Rate for Payer: Humana Medicare Advantage |
$11,834.40
|
| Rate for Payer: Kentucky WC Medicaid |
$11,355.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,201.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,467.53
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$9,156.18
|
|
|
Service Code
|
MSDRG 694
|
| Min. Negotiated Rate |
$6,213.12 |
| Max. Negotiated Rate |
$9,156.18 |
| Rate for Payer: Anthem Medicaid |
$6,213.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,540.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,156.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,829.18
|
| Rate for Payer: Humana KY Medicaid |
$6,213.12
|
| Rate for Payer: Humana Medicare Advantage |
$6,540.13
|
| Rate for Payer: Kentucky WC Medicaid |
$6,275.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,848.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,337.39
|
|
|
URINE CHLORIDE (24HR)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
30000278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
URINE CHLORIDE (24HR)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
30000278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.75
|
| Rate for Payer: Humana Medicare Advantage |
$5.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
URINE CREATININE CLR (24HR)
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
30000299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.16
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
URINE CREATININE CLR (24HR)
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
30000299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$9.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.46
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$9.46
|
| Rate for Payer: Humana Medicare Advantage |
$9.46
|
| Rate for Payer: Kentucky WC Medicaid |
$9.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| 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 |
$41.76
|
| 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
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Professional
|
Both
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| 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
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$579.00
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$16.21
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.30
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.56
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.49
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem Medicaid |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.60
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Humana KY Medicaid |
$12.60
|
| Rate for Payer: Humana Medicare Advantage |
$12.60
|
| Rate for Payer: Kentucky WC Medicaid |
$12.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.49
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
URINE DRUG SCREEN CLASS A AUTO
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.12
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
URINE DRUG SCREEN CLASS A AUTO
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
