|
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 |
$37.80 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Ambetter Exchange |
$6.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$6.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.23
|
|
|
UR ALBUMIN CREATININE POC
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.90 |
| 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 |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.47
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
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 |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| 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 |
$19.20 |
| 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 |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
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 |
$38.40 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Ambetter Exchange |
$6.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$6.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.23
|
|
|
UREA 15GM PACKET
|
Facility
|
IP
|
$11.63
|
|
|
Service Code
|
NDC 62530000011
|
| Hospital Charge Code |
25004263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| 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 |
$9.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.02
|
| 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 |
$3.49 |
| 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 |
$9.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.02
|
| Rate for Payer: PHCS Commercial |
$11.16
|
| Rate for Payer: United Healthcare All Payer |
$10.23
|
|
|
UREA 40% CRM (198GM)
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 44523061707
|
| Hospital Charge Code |
25003551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| 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 |
$1.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$1.59
|
| Rate for Payer: United Healthcare All Payer |
$1.46
|
|
|
UREA 40% CRM (198GM)
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
NDC 44523061707
|
| Hospital Charge Code |
25003551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| 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 |
$1.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$1.59
|
| Rate for Payer: United Healthcare All Payer |
$1.46
|
|
|
UREA NITROGEN CLEARANCE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 84545
|
| Hospital Charge Code |
30000549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
UREA NITROGEN CLEARANCE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 84545
|
| Hospital Charge Code |
30000549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| 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 |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
UREAPLASMA CULTURE
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
30001282
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.20 |
| 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 |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
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 |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| 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 |
$98.40 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Ambetter Exchange |
$15.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$15.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.39
|
| Rate for Payer: Multiplan PHCS |
$98.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.01
|
| Rate for Payer: UHCCP Medicaid |
$57.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.39
|
|
|
URECHOLINE(BETHANECH 10MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 832051100
|
| Hospital Charge Code |
25001631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| 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 |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
URECHOLINE(BETHANECH 25MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 832051200
|
| Hospital Charge Code |
25001632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| 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 |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
URECHOLINE(BETHANECH 25MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 832051200
|
| Hospital Charge Code |
25001632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| 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 |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
URETERSCOPE FLEX DISPOSABLE
|
Facility
|
OP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27000282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem Medicaid |
$1,790.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Humana KY Medicaid |
$1,790.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,808.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,826.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
URETERSCOPE FLEX DISPOSABLE
|
Facility
|
IP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27000282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
URETHRLYS TRANSVAG W/ SCOPE
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
HCPCS 53500
|
| Hospital Charge Code |
76102968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.60 |
| Max. Negotiated Rate |
$1,197.78 |
| Rate for Payer: Aetna Commercial |
$1,197.78
|
| Rate for Payer: Ambetter Exchange |
$707.91
|
| Rate for Payer: Anthem Medicaid |
$533.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$849.49
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$1,094.77
|
| Rate for Payer: Healthspan PPO |
$957.73
|
| Rate for Payer: Humana Medicaid |
$533.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,020.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$707.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$544.27
|
| Rate for Payer: Molina Healthcare Passport |
$533.60
|
| Rate for Payer: Multiplan PHCS |
$1,089.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$920.28
|
| Rate for Payer: UHCCP Medicaid |
$635.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$538.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.91
|
|
|
URETHRLYS TRANSVAG W/ SCOPE
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
HCPCS 53500
|
| Hospital Charge Code |
76102968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$1,742.40 |
| Rate for Payer: Aetna Commercial |
$1,397.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.70
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$1,506.45
|
| Rate for Payer: First Health Commercial |
$1,724.25
|
| Rate for Payer: Humana Commercial |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,252.35
|
| Rate for Payer: PHCS Commercial |
$1,742.40
|
| Rate for Payer: United Healthcare All Payer |
$1,597.20
|
|
|
URETHRLYS TRANSVAG W/ SCOPE
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
HCPCS 53500
|
| Hospital Charge Code |
76102968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.18 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,397.55
|
| Rate for Payer: Anthem Medicaid |
$624.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$1,506.45
|
| Rate for Payer: First Health Commercial |
$1,724.25
|
| Rate for Payer: Humana Commercial |
$1,542.75
|
| Rate for Payer: Humana KY Medicaid |
$624.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$630.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,252.35
|
| Rate for Payer: PHCS Commercial |
$1,742.40
|
| Rate for Payer: United Healthcare All Payer |
$1,597.20
|
|
|
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 53450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)
|
Facility
|
OP
|
$6,576.02
|
|
|
Service Code
|
CPT 53400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,697.16 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
|
