|
UROLIFT 2 IMPLANT CARTRIDGE
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
UROLIFT 2 IMPLANT CRTRDGE HAND
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
UROLIFT 2 IMPLANT CRTRDGE HAND
|
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
|
|
|
UROPASS URET SHEATH 12/14 38CM
|
Facility
|
OP
|
$1,807.41
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.22 |
| Max. Negotiated Rate |
$1,735.11 |
| Rate for Payer: Aetna Commercial |
$1,391.71
|
| Rate for Payer: Anthem Medicaid |
$621.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,409.78
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: Cigna Commercial |
$1,500.15
|
| Rate for Payer: First Health Commercial |
$1,717.04
|
| Rate for Payer: Humana Commercial |
$1,536.30
|
| Rate for Payer: Humana KY Medicaid |
$621.57
|
| Rate for Payer: Kentucky WC Medicaid |
$627.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,590.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,355.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,572.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,247.11
|
| Rate for Payer: PHCS Commercial |
$1,735.11
|
| Rate for Payer: United Healthcare All Payer |
$1,590.52
|
|
|
UROPASS URET SHEATH 12/14 38CM
|
Facility
|
IP
|
$1,807.41
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.22 |
| Max. Negotiated Rate |
$1,735.11 |
| Rate for Payer: Aetna Commercial |
$1,391.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,409.78
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: Cigna Commercial |
$1,500.15
|
| Rate for Payer: First Health Commercial |
$1,717.04
|
| Rate for Payer: Humana Commercial |
$1,536.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,590.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,355.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,572.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,247.11
|
| Rate for Payer: PHCS Commercial |
$1,735.11
|
| Rate for Payer: United Healthcare All Payer |
$1,590.52
|
|
|
UROXATRAL(ALFUZOSIN)20MG TAB
|
Facility
|
OP
|
$67.68
|
|
|
Service Code
|
NDC 59212020010
|
| Hospital Charge Code |
25003788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$64.97 |
| Rate for Payer: Aetna Commercial |
$52.11
|
| Rate for Payer: Anthem Medicaid |
$23.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.79
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cigna Commercial |
$56.17
|
| Rate for Payer: First Health Commercial |
$64.30
|
| Rate for Payer: Humana Commercial |
$57.53
|
| Rate for Payer: Humana KY Medicaid |
$23.28
|
| Rate for Payer: Kentucky WC Medicaid |
$23.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.56
|
| Rate for Payer: Ohio Health Group HMO |
$50.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.70
|
| Rate for Payer: PHCS Commercial |
$64.97
|
| Rate for Payer: United Healthcare All Payer |
$59.56
|
|
|
UROXATRAL(ALFUZOSIN)20MG TAB
|
Facility
|
IP
|
$67.68
|
|
|
Service Code
|
NDC 59212020010
|
| Hospital Charge Code |
25003788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$64.97 |
| Rate for Payer: Aetna Commercial |
$52.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.79
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cigna Commercial |
$56.17
|
| Rate for Payer: First Health Commercial |
$64.30
|
| Rate for Payer: Humana Commercial |
$57.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.56
|
| Rate for Payer: Ohio Health Group HMO |
$50.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.70
|
| Rate for Payer: PHCS Commercial |
$64.97
|
| Rate for Payer: United Healthcare All Payer |
$59.56
|
|
|
URSO 250MG TABLET
|
Facility
|
OP
|
$10.15
|
|
|
Service Code
|
NDC 68001037700
|
| Hospital Charge Code |
25001637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem Medicaid |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Humana KY Medicaid |
$3.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.00
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
URSO 250MG TABLET
|
Facility
|
IP
|
$10.15
|
|
|
Service Code
|
NDC 68001037700
|
| Hospital Charge Code |
25001637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.00
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
URSO 500MG TABLET
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
NDC 68001037800
|
| Hospital Charge Code |
25004532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Humana KY Medicaid |
$4.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
URSO 500MG TABLET
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
NDC 68001037800
|
| Hospital Charge Code |
25004532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
URTRO-RENSCOE SHEATH W/DILATOR
|
Facility
|
OP
|
$1,490.70
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.21 |
| Max. Negotiated Rate |
$1,431.07 |
| Rate for Payer: Aetna Commercial |
$1,147.84
|
| Rate for Payer: Anthem Medicaid |
$512.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.75
|
| Rate for Payer: Cash Price |
$745.35
|
| Rate for Payer: Cigna Commercial |
$1,237.28
|
| Rate for Payer: First Health Commercial |
$1,416.16
|
| Rate for Payer: Humana Commercial |
$1,267.10
|
| Rate for Payer: Humana KY Medicaid |
$512.65
|
| Rate for Payer: Kentucky WC Medicaid |
$517.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,296.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.58
|
| Rate for Payer: PHCS Commercial |
$1,431.07
|
| Rate for Payer: United Healthcare All Payer |
$1,311.82
|
|
|
URTRO-RENSCOE SHEATH W/DILATOR
|
Facility
|
IP
|
$1,490.70
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.21 |
| Max. Negotiated Rate |
$1,431.07 |
| Rate for Payer: Aetna Commercial |
$1,147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.75
|
| Rate for Payer: Cash Price |
$745.35
|
| Rate for Payer: Cigna Commercial |
$1,237.28
|
| Rate for Payer: First Health Commercial |
$1,416.16
|
| Rate for Payer: Humana Commercial |
$1,267.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,296.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.58
|
| Rate for Payer: PHCS Commercial |
$1,431.07
|
| Rate for Payer: United Healthcare All Payer |
$1,311.82
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
US ABD ASCITES SURVEY LIMITED
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
US ABD ASCITES SURVEY LIMITE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
US ABD ASCITES SURVEY LIMITE(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
US ABD ASCITES SURVEY LIMITE(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
US ABDL AORTA SCREEN AAA
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Ambetter Exchange |
$96.04
|
| Rate for Payer: Anthem Medicaid |
$71.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.25
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$148.48
|
| Rate for Payer: Humana Medicaid |
$71.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.50
|
| Rate for Payer: Molina Healthcare Passport |
$71.08
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.85
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.04
|
|
|
US ABDL AORTA SCREEN AAA(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402P0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Ambetter Exchange |
$96.04
|
| Rate for Payer: Anthem Medicaid |
$71.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.25
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$148.48
|
| Rate for Payer: Humana Medicaid |
$71.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.50
|
| Rate for Payer: Molina Healthcare Passport |
$71.08
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.85
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.04
|
|
|
US ABDL AORTA SCREEN AAA(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402T0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
US ABDL AORTA SCREEN AAA(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402T0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
