|
URINE DRUG SCREEN SINGLE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
URINE DRUG SCREEN SINGLE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.60
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| 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 |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
URINE POTASSIUM RANDOM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
30000481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$4.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.73
|
| 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 |
$4.73
|
| Rate for Payer: Humana Medicare Advantage |
$4.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4.78
|
| 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 |
$5.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.82
|
| 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 POTASSIUM RANDOM
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
30000481
|
|
Hospital Revenue Code
|
300
|
| 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 PROTEIN
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
URINE PROTEIN
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
URINE REDUCING SUBSTANCE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84377
|
| Hospital Charge Code |
30000519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
URINE REDUCING SUBSTANCE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84377
|
| Hospital Charge Code |
30000519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$5.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Humana KY Medicaid |
$5.50
|
| Rate for Payer: Humana Medicare Advantage |
$5.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
URINE SODIUM
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
30000512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$5.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.06
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$5.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
URINE SODIUM
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
30000512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
URINE-UREA NITROGEN
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
30000548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$5.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.56
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$5.56
|
| Rate for Payer: Humana Medicare Advantage |
$5.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
URINE-UREA NITROGEN
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
30000548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
URINE-URIC ACID (24HR)
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
30000551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.36
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
URINE-URIC ACID (24HR)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
30000551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$5.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$5.08
|
| Rate for Payer: Humana Medicare Advantage |
$5.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
URISPAS (FLAVOXATE) 100MG/1TAB
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 42806005801
|
| Hospital Charge Code |
25001633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
URISPAS (FLAVOXATE) 100MG/1TAB
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 42806005801
|
| Hospital Charge Code |
25001633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
UROBILINOGEN URINE QUAL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 84578
|
| Hospital Charge Code |
30000552
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$27.84 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.29
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$24.07
|
| Rate for Payer: First Health Commercial |
$27.55
|
| Rate for Payer: Humana Commercial |
$24.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.52
|
| Rate for Payer: Ohio Health Group HMO |
$21.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.99
|
| Rate for Payer: PHCS Commercial |
$27.84
|
| Rate for Payer: United Healthcare All Payer |
$25.52
|
|
|
UROBILINOGEN URINE QUAL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 84578
|
| Hospital Charge Code |
30000552
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$27.84 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.47
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$24.07
|
| Rate for Payer: First Health Commercial |
$27.55
|
| Rate for Payer: Humana Commercial |
$24.65
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Humana Medicare Advantage |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.52
|
| Rate for Payer: Ohio Health Group HMO |
$21.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.99
|
| Rate for Payer: PHCS Commercial |
$27.84
|
| Rate for Payer: United Healthcare All Payer |
$25.52
|
|
|
UROCIT-K 10MEQ TABLET SA
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
25001635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
UROCIT-K 10MEQ TABLET SA
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
25001635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
UROCIT K 5MEQ TAB
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 245007011
|
| Hospital Charge Code |
25001634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
UROCIT K 5MEQ TAB
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 245007011
|
| Hospital Charge Code |
25001634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Anthem Medicaid |
$50.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$588.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$101.19
|
| Rate for Payer: Healthspan PPO |
$237.76
|
| Rate for Payer: Humana Medicaid |
$50.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.55
|
| Rate for Payer: Molina Healthcare Passport |
$50.54
|
| Rate for Payer: Multiplan PHCS |
$352.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$411.60
|
| Rate for Payer: UHCCP Medicaid |
$205.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.05
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem Medicaid |
$202.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Humana KY Medicaid |
$202.21
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$204.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.28
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.28
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
