|
URINE PROTEIN
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
URINE PROTEIN
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
30000494
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
URINE REDUCING SUBSTANCE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84377
|
| Hospital Charge Code |
30000519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
URINE REDUCING SUBSTANCE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84377
|
| Hospital Charge Code |
30000519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$5.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Humana KY Medicaid |
$5.50
|
| Rate for Payer: Humana Medicare Advantage |
$5.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
URINE SODIUM
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
30000512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
URINE SODIUM
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
30000512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$5.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.06
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$5.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
URINE-UREA NITROGEN
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
30000548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
URINE-UREA NITROGEN
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
30000548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$5.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.56
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$5.56
|
| Rate for Payer: Humana Medicare Advantage |
$5.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
URINE-URIC ACID (24HR)
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
30000551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$5.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$5.08
|
| Rate for Payer: Humana Medicare Advantage |
$5.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
URINE-URIC ACID (24HR)
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
30000551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
URISPAS (FLAVOXATE) 100MG/1TAB
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 42806005801
|
| Hospital Charge Code |
25001633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
URISPAS (FLAVOXATE) 100MG/1TAB
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 42806005801
|
| Hospital Charge Code |
25001633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
UROBILINOGEN URINE QUAL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 84578
|
| Hospital Charge Code |
30000552
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$27.84 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.47
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$24.07
|
| Rate for Payer: First Health Commercial |
$27.55
|
| Rate for Payer: Humana Commercial |
$24.65
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Humana Medicare Advantage |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.52
|
| Rate for Payer: Ohio Health Group HMO |
$21.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
| Rate for Payer: PHCS Commercial |
$27.84
|
| Rate for Payer: United Healthcare All Payer |
$25.52
|
|
|
UROBILINOGEN URINE QUAL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 84578
|
| Hospital Charge Code |
30000552
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$27.84 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.29
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$24.07
|
| Rate for Payer: First Health Commercial |
$27.55
|
| Rate for Payer: Humana Commercial |
$24.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.52
|
| Rate for Payer: Ohio Health Group HMO |
$21.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
| Rate for Payer: PHCS Commercial |
$27.84
|
| Rate for Payer: United Healthcare All Payer |
$25.52
|
|
|
UROCIT-K 10MEQ TABLET SA
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
25001635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
UROCIT-K 10MEQ TABLET SA
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 31722013001
|
| Hospital Charge Code |
25001635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
UROCIT K 5MEQ TAB
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 245007011
|
| Hospital Charge Code |
25001634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.22
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
UROCIT K 5MEQ TAB
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 245007011
|
| Hospital Charge Code |
25001634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.22
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Ambetter Exchange |
$119.50
|
| Rate for Payer: Anthem Medicaid |
$50.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.40
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.55
|
| Rate for Payer: Molina Healthcare Passport |
$50.54
|
| Rate for Payer: Multiplan PHCS |
$372.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.35
|
| Rate for Payer: UHCCP Medicaid |
$217.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.50
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$478.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.38
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$515.43
|
| Rate for Payer: First Health Commercial |
$589.95
|
| Rate for Payer: Humana Commercial |
$527.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.48
|
| Rate for Payer: Ohio Health Group HMO |
$465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$428.49
|
| Rate for Payer: PHCS Commercial |
$596.16
|
| Rate for Payer: United Healthcare All Payer |
$546.48
|
|
|
UROGRAPHY ANTEGRADE RS&I
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.56 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$478.17
|
| Rate for Payer: Anthem Medicaid |
$213.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$515.43
|
| Rate for Payer: First Health Commercial |
$589.95
|
| Rate for Payer: Humana Commercial |
$527.85
|
| Rate for Payer: Humana KY Medicaid |
$213.56
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$215.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.48
|
| Rate for Payer: Ohio Health Group HMO |
$465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$428.49
|
| Rate for Payer: PHCS Commercial |
$596.16
|
| Rate for Payer: United Healthcare All Payer |
$546.48
|
|
|
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: Ambetter Exchange |
$119.50
|
| Rate for Payer: Anthem Medicaid |
$50.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.50
|
| 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 |
$155.35
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.50
|
|
|
UROGRAPHY ANTEGRADE RS&I (T
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
320T0145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
UROGRAPHY ANTEGRADE RS&I (T
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
320T0145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.77 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$187.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$187.77
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$189.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
UROLIFT 2 IMPLANT CARTRIDGE
|
Facility
|
OP
|
$6,741.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,022.38 |
| Max. Negotiated Rate |
$6,471.60 |
| Rate for Payer: Aetna Commercial |
$5,190.76
|
| Rate for Payer: Anthem Medicaid |
$2,318.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.18
|
| Rate for Payer: Cash Price |
$3,370.62
|
| Rate for Payer: Cigna Commercial |
$5,595.24
|
| Rate for Payer: First Health Commercial |
$6,404.19
|
| Rate for Payer: Humana Commercial |
$5,730.06
|
| Rate for Payer: Humana KY Medicaid |
$2,318.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,341.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,527.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,055.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,864.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,651.46
|
| Rate for Payer: PHCS Commercial |
$6,471.60
|
| Rate for Payer: United Healthcare All Payer |
$5,932.30
|
|
