|
PROGEL PLEURAL SEALANT KIT
|
Facility
|
IP
|
$5,507.50
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
25001808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$715.98 |
| Max. Negotiated Rate |
$5,287.20 |
| Rate for Payer: Aetna Commercial |
$4,240.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,295.85
|
| Rate for Payer: Cash Price |
$2,753.75
|
| Rate for Payer: Cigna Commercial |
$4,571.22
|
| Rate for Payer: First Health Commercial |
$5,232.12
|
| Rate for Payer: Humana Commercial |
$4,681.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,516.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,064.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,652.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,846.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,130.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,101.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.32
|
| Rate for Payer: PHCS Commercial |
$5,287.20
|
| Rate for Payer: United Healthcare All Payer |
$4,846.60
|
|
|
PROGEL PLEURAL SEALANT KIT
|
Facility
|
OP
|
$5,507.50
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
25001808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$715.98 |
| Max. Negotiated Rate |
$5,287.20 |
| Rate for Payer: Aetna Commercial |
$4,240.78
|
| Rate for Payer: Anthem Medicaid |
$1,894.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,295.85
|
| Rate for Payer: Cash Price |
$2,753.75
|
| Rate for Payer: Cigna Commercial |
$4,571.22
|
| Rate for Payer: First Health Commercial |
$5,232.12
|
| Rate for Payer: Humana Commercial |
$4,681.38
|
| Rate for Payer: Humana KY Medicaid |
$1,894.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,913.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,516.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,064.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,652.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,932.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,846.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,130.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,101.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.32
|
| Rate for Payer: PHCS Commercial |
$5,287.20
|
| Rate for Payer: United Healthcare All Payer |
$4,846.60
|
|
|
PROGESTERONE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$36.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: Healthspan PPO |
$20.08
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.52
|
|
|
PROGESTERONE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$20.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.86
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$20.86
|
| Rate for Payer: Humana Medicare Advantage |
$20.86
|
| Rate for Payer: Kentucky WC Medicaid |
$21.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
PROGESTERONE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
PROGESTERONE/OIL 50MG/ML 10MLV
|
Facility
|
IP
|
$185.90
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
25002323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$178.46 |
| Rate for Payer: Aetna Commercial |
$143.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.00
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cigna Commercial |
$154.30
|
| Rate for Payer: First Health Commercial |
$176.60
|
| Rate for Payer: Humana Commercial |
$158.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.59
|
| Rate for Payer: Ohio Health Group HMO |
$139.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.63
|
| Rate for Payer: PHCS Commercial |
$178.46
|
| Rate for Payer: United Healthcare All Payer |
$163.59
|
|
|
PROGESTERONE/OIL 50MG/ML 10MLV
|
Facility
|
OP
|
$185.90
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
25002323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$178.46 |
| Rate for Payer: Aetna Commercial |
$143.14
|
| Rate for Payer: Anthem Medicaid |
$63.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.00
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cigna Commercial |
$154.30
|
| Rate for Payer: First Health Commercial |
$176.60
|
| Rate for Payer: Humana Commercial |
$158.02
|
| Rate for Payer: Humana KY Medicaid |
$63.93
|
| Rate for Payer: Kentucky WC Medicaid |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.59
|
| Rate for Payer: Ohio Health Group HMO |
$139.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.63
|
| Rate for Payer: PHCS Commercial |
$178.46
|
| Rate for Payer: United Healthcare All Payer |
$163.59
|
|
|
PROGRAF 0.5MG CAPSULE
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
PROGRAF 0.5MG CAPSULE
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
PROGRAF 1MG CAPSULE
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
| Rate for Payer: Aetna Commercial |
$7.32
|
|
|
PROGRAF 1MG CAPSULE
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Anthem Medicaid |
$54.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.00
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$108.52
|
| Rate for Payer: Healthspan PPO |
$100.74
|
| Rate for Payer: Humana Medicaid |
$54.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.39
|
| Rate for Payer: Molina Healthcare Passport |
$54.30
|
| Rate for Payer: Multiplan PHCS |
$83.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.30
|
| Rate for Payer: UHCCP Medicaid |
$48.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.84
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$49.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Humana KY Medicaid |
$49.87
|
| Rate for Payer: Humana Medicare Advantage |
$32.61
|
| Rate for Payer: Kentucky WC Medicaid |
$50.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.95
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.10
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.95
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
PROGREAT 2.8FR 130CM
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
PROGREAT 2.8FR 130CM
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem Medicaid |
$1,382.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Humana KY Medicaid |
$1,382.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,396.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
PROGREAT MICROCATHTR 20F 150CM
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
PROGREAT MICROCATHTR 20F 150CM
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
PROLACTIN SERUM
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem Medicaid |
$19.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Humana KY Medicaid |
$19.38
|
| Rate for Payer: Humana Medicare Advantage |
$19.38
|
| Rate for Payer: Kentucky WC Medicaid |
$19.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
PROLACTIN SERUM
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.11
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
PROLACTIN SERUM
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$17.02
|
| Rate for Payer: Healthspan PPO |
$20.31
|
| Rate for Payer: Multiplan PHCS |
$142.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.60
|
| Rate for Payer: UHCCP Medicaid |
$83.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.63
|
|
|
PROLASTIN-C 10MG (1000MG VL)
|
Facility
|
OP
|
$3,106.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25003386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$2,982.24 |
| Rate for Payer: Aetna Commercial |
$2,392.00
|
| Rate for Payer: Anthem Medicaid |
$1,068.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,423.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cigna Commercial |
$2,578.40
|
| Rate for Payer: First Health Commercial |
$2,951.18
|
| Rate for Payer: Humana Commercial |
$2,640.52
|
| Rate for Payer: Humana KY Medicaid |
$1,068.33
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,079.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$963.02
|
| Rate for Payer: PHCS Commercial |
$2,982.24
|
| Rate for Payer: United Healthcare All Payer |
$2,733.72
|
|
|
PROLASTIN-C 10MG (1000MG VL)
|
Facility
|
IP
|
$3,106.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25003386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$403.84 |
| Max. Negotiated Rate |
$2,982.24 |
| Rate for Payer: Aetna Commercial |
$2,392.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,423.07
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cigna Commercial |
$2,578.40
|
| Rate for Payer: First Health Commercial |
$2,951.18
|
| Rate for Payer: Humana Commercial |
$2,640.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$963.02
|
| Rate for Payer: PHCS Commercial |
$2,982.24
|
| Rate for Payer: United Healthcare All Payer |
$2,733.72
|
|
|
PROLIA 60MG/ML SYRINGE
|
Facility
|
OP
|
$9,734.35
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
25002005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$9,344.98 |
| Rate for Payer: Aetna Commercial |
$7,495.45
|
| Rate for Payer: Anthem Medicaid |
$3,347.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,592.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.02
|
| Rate for Payer: Cash Price |
$4,867.18
|
| Rate for Payer: Cash Price |
$4,867.18
|
| Rate for Payer: Cigna Commercial |
$8,079.51
|
| Rate for Payer: First Health Commercial |
$9,247.63
|
| Rate for Payer: Humana Commercial |
$8,274.20
|
| Rate for Payer: Humana KY Medicaid |
$3,347.64
|
| Rate for Payer: Humana Medicare Advantage |
$25.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,183.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,414.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,300.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.65
|
| Rate for Payer: PHCS Commercial |
$9,344.98
|
| Rate for Payer: United Healthcare All Payer |
$8,566.23
|
|
|
PROLIA 60MG/ML SYRINGE
|
Facility
|
IP
|
$9,734.35
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
25002005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.47 |
| Max. Negotiated Rate |
$9,344.98 |
| Rate for Payer: Aetna Commercial |
$7,495.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,592.79
|
| Rate for Payer: Cash Price |
$4,867.18
|
| Rate for Payer: Cigna Commercial |
$8,079.51
|
| Rate for Payer: First Health Commercial |
$9,247.63
|
| Rate for Payer: Humana Commercial |
$8,274.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,183.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,300.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.65
|
| Rate for Payer: PHCS Commercial |
$9,344.98
|
| Rate for Payer: United Healthcare All Payer |
$8,566.23
|
|
