|
URIC ACID - BLOOD
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
URIC ACID - BLOOD
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Aetna Commercial |
$10.49
|
| Rate for Payer: Ambetter Exchange |
$4.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.42
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: Healthspan PPO |
$4.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.52
|
| Rate for Payer: Multiplan PHCS |
$36.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$21.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.52
|
|
|
URIC ACID - BLOOD
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
30000550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$4.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.52
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$4.52
|
| Rate for Payer: Humana Medicare Advantage |
$4.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
URINALYSIS
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
URINALYSIS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Ambetter Exchange |
$2.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.70
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: Healthspan PPO |
$2.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.25
|
| Rate for Payer: Multiplan PHCS |
$22.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.92
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.25
|
|
|
URINALYSIS
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30000178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$2.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$2.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$2.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$2.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
URINALYSIS AUTO W/O SCOPE POC
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
30001928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Ambetter Exchange |
$2.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.70
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: Healthspan PPO |
$2.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.25
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.92
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.25
|
|
|
URINE CHLORIDE (24HR)
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
30000278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.75
|
| 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 |
$5.75
|
| Rate for Payer: Humana Medicare Advantage |
$5.75
|
| Rate for Payer: Kentucky WC Medicaid |
$5.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.87
|
| 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 |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
URINE CHLORIDE (24HR)
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
30000278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.70 |
| 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 |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
URINE CREATININE CLR (24HR)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
30000299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
URINE CREATININE CLR (24HR)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
30000299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$9.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.46
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$9.46
|
| Rate for Payer: Humana Medicare Advantage |
$9.46
|
| Rate for Payer: Kentucky WC Medicaid |
$9.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Professional
|
Both
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
|
|
URINE DRG SCRN CLASSA AUTOSNGL
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
30001802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.76
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.70 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$463.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.51
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Ambetter Exchange |
$12.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.12
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$16.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.38
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.60
|
|
|
URINE DRUG OF ABUSE PANEL KIT
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem Medicaid |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.60
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Humana KY Medicaid |
$12.60
|
| Rate for Payer: Humana Medicare Advantage |
$12.60
|
| Rate for Payer: Kentucky WC Medicaid |
$12.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$463.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.51
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
URINE DRUG SCREEN CLASS A AUTO
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.80
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
URINE DRUG SCREEN CLASS A AUTO
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
URINE DRUG SCREEN SINGLE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
30000064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.70 |
| 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 |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| 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 |
$12.60 |
| 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 |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.71
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
URINE POTASSIUM RANDOM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
30000481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$4.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.73
|
| 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 |
$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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.82
|
| 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 |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
URINE POTASSIUM RANDOM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
30000481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.70 |
| 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 |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
