|
UROGRAPHY ANTEGRADE RS&I (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
320P0145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Anthem Medicaid |
$50.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| 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 |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.05
|
|
|
UROGRAPHY ANTEGRADE RS&I (T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
320T0145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
UROGRAPHY ANTEGRADE RS&I (T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
320T0145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
UROLIFT 2 IMPLANT CARTRIDGE
|
Facility
|
IP
|
$19,765.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.45 |
| Max. Negotiated Rate |
$18,974.40 |
| Rate for Payer: Aetna Commercial |
$15,219.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,416.70
|
| Rate for Payer: Cash Price |
$9,882.50
|
| Rate for Payer: Cigna Commercial |
$16,404.95
|
| Rate for Payer: First Health Commercial |
$18,776.75
|
| Rate for Payer: Humana Commercial |
$16,800.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,207.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,586.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,393.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,823.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,953.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,569.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.15
|
| Rate for Payer: PHCS Commercial |
$18,974.40
|
| Rate for Payer: United Healthcare All Payer |
$17,393.20
|
|
|
UROLIFT 2 IMPLANT CARTRIDGE
|
Facility
|
OP
|
$19,765.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.45 |
| Max. Negotiated Rate |
$18,974.40 |
| Rate for Payer: Aetna Commercial |
$15,219.05
|
| Rate for Payer: Anthem Medicaid |
$6,797.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,416.70
|
| Rate for Payer: Cash Price |
$9,882.50
|
| Rate for Payer: Cigna Commercial |
$16,404.95
|
| Rate for Payer: First Health Commercial |
$18,776.75
|
| Rate for Payer: Humana Commercial |
$16,800.25
|
| Rate for Payer: Humana KY Medicaid |
$6,797.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,866.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,207.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,586.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,929.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,933.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,393.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,823.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,953.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,569.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.15
|
| Rate for Payer: PHCS Commercial |
$18,974.40
|
| Rate for Payer: United Healthcare All Payer |
$17,393.20
|
|
|
UROLIFT 2 IMPLANT CRTRDGE HAND
|
Facility
|
IP
|
$6,541.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.36 |
| Max. Negotiated Rate |
$6,279.60 |
| Rate for Payer: Aetna Commercial |
$5,036.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,102.18
|
| Rate for Payer: Cash Price |
$3,270.62
|
| Rate for Payer: Cigna Commercial |
$5,429.24
|
| Rate for Payer: First Health Commercial |
$6,214.19
|
| Rate for Payer: Humana Commercial |
$5,560.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,363.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,827.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,962.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,756.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,905.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,308.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.79
|
| Rate for Payer: PHCS Commercial |
$6,279.60
|
| Rate for Payer: United Healthcare All Payer |
$5,756.30
|
|
|
UROLIFT 2 IMPLANT CRTRDGE HAND
|
Facility
|
OP
|
$6,541.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.36 |
| Max. Negotiated Rate |
$6,279.60 |
| Rate for Payer: United Healthcare All Payer |
$5,756.30
|
| Rate for Payer: Aetna Commercial |
$5,036.76
|
| Rate for Payer: Anthem Medicaid |
$2,249.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,102.18
|
| Rate for Payer: Cash Price |
$3,270.62
|
| Rate for Payer: Cigna Commercial |
$5,429.24
|
| Rate for Payer: First Health Commercial |
$6,214.19
|
| Rate for Payer: Humana Commercial |
$5,560.06
|
| Rate for Payer: Humana KY Medicaid |
$2,249.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,272.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,363.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,827.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,962.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,756.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,905.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,308.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.79
|
| Rate for Payer: PHCS Commercial |
$6,279.60
|
|
|
UROPASS URET SHEATH 12/14 38CM
|
Facility
|
OP
|
$1,817.35
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.26 |
| Max. Negotiated Rate |
$1,744.66 |
| Rate for Payer: Aetna Commercial |
$1,399.36
|
| Rate for Payer: Anthem Medicaid |
$624.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.53
|
| Rate for Payer: Cash Price |
$908.67
|
| Rate for Payer: Cigna Commercial |
$1,508.40
|
| Rate for Payer: First Health Commercial |
$1,726.48
|
| Rate for Payer: Humana Commercial |
$1,544.75
|
| Rate for Payer: Humana KY Medicaid |
$624.99
|
| Rate for Payer: Kentucky WC Medicaid |
$631.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.38
|
| Rate for Payer: PHCS Commercial |
$1,744.66
|
| Rate for Payer: United Healthcare All Payer |
$1,599.27
|
|
|
UROPASS URET SHEATH 12/14 38CM
|
Facility
|
IP
|
$1,817.35
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.26 |
| Max. Negotiated Rate |
$1,744.66 |
| Rate for Payer: Aetna Commercial |
$1,399.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.53
|
| Rate for Payer: Cash Price |
$908.67
|
| Rate for Payer: Cigna Commercial |
$1,508.40
|
| Rate for Payer: First Health Commercial |
$1,726.48
|
| Rate for Payer: Humana Commercial |
$1,544.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.38
|
| Rate for Payer: PHCS Commercial |
$1,744.66
|
| Rate for Payer: United Healthcare All Payer |
$1,599.27
|
|
|
UROXATRAL(ALFUZOSIN)20MG TAB
|
Facility
|
OP
|
$66.11
|
|
|
Service Code
|
NDC 59212020010
|
| Hospital Charge Code |
25003788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem Medicaid |
$22.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.57
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.87
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.19
|
| Rate for Payer: Humana KY Medicaid |
$22.74
|
| Rate for Payer: Kentucky WC Medicaid |
$22.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.18
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.47
|
| Rate for Payer: United Healthcare All Payer |
$58.18
|
|
|
UROXATRAL(ALFUZOSIN)20MG TAB
|
Facility
|
IP
|
$66.11
|
|
|
Service Code
|
NDC 59212020010
|
| Hospital Charge Code |
25003788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.57
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.87
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.18
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.47
|
| Rate for Payer: United Healthcare All Payer |
$58.18
|
|
|
URSO 250MG TABLET
|
Facility
|
OP
|
$10.15
|
|
|
Service Code
|
NDC 68001037700
|
| Hospital Charge Code |
25001637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem Medicaid |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Humana KY Medicaid |
$3.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
URSO 250MG TABLET
|
Facility
|
IP
|
$10.15
|
|
|
Service Code
|
NDC 68001037700
|
| Hospital Charge Code |
25001637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
URSO 500MG TABLET
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
NDC 68001037800
|
| Hospital Charge Code |
25004532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Humana KY Medicaid |
$4.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.66
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
URSO 500MG TABLET
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
NDC 68001037800
|
| Hospital Charge Code |
25004532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.66
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
URTRO-RENSCOE SHEATH W/DILATOR
|
Facility
|
OP
|
$1,517.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.31 |
| Max. Negotiated Rate |
$1,457.04 |
| Rate for Payer: Aetna Commercial |
$1,168.67
|
| Rate for Payer: Anthem Medicaid |
$521.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,183.84
|
| Rate for Payer: Cash Price |
$758.88
|
| Rate for Payer: Cigna Commercial |
$1,259.73
|
| Rate for Payer: First Health Commercial |
$1,441.86
|
| Rate for Payer: Humana Commercial |
$1,290.09
|
| Rate for Payer: Humana KY Medicaid |
$521.95
|
| Rate for Payer: Kentucky WC Medicaid |
$527.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.50
|
| Rate for Payer: PHCS Commercial |
$1,457.04
|
| Rate for Payer: United Healthcare All Payer |
$1,335.62
|
|
|
URTRO-RENSCOE SHEATH W/DILATOR
|
Facility
|
IP
|
$1,517.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.31 |
| Max. Negotiated Rate |
$1,457.04 |
| Rate for Payer: Aetna Commercial |
$1,168.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,183.84
|
| Rate for Payer: Cash Price |
$758.88
|
| Rate for Payer: Cigna Commercial |
$1,259.73
|
| Rate for Payer: First Health Commercial |
$1,441.86
|
| Rate for Payer: Humana Commercial |
$1,290.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.50
|
| Rate for Payer: PHCS Commercial |
$1,457.04
|
| Rate for Payer: United Healthcare All Payer |
$1,335.62
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem Medicaid |
$379.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Humana KY Medicaid |
$379.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,104.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$662.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.80
|
| Rate for Payer: UHCCP Medicaid |
$386.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
US ABD ASCITES SURVEY LIMITE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
US ABD ASCITES SURVEY LIMITE(T
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.27 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
US ABD ASCITES SURVEY LIMITE(T
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem Medicaid |
$336.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Humana KY Medicaid |
$336.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$340.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
