|
PROMODEL ORTHOBIOLGC IMPT 10CC
|
Facility
|
OP
|
$11,764.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.37 |
| Max. Negotiated Rate |
$11,293.78 |
| Rate for Payer: Aetna Commercial |
$9,058.55
|
| Rate for Payer: Anthem Medicaid |
$4,045.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.19
|
| Rate for Payer: Cash Price |
$5,882.18
|
| Rate for Payer: Cigna Commercial |
$9,764.41
|
| Rate for Payer: First Health Commercial |
$11,176.13
|
| Rate for Payer: Humana Commercial |
$9,999.70
|
| Rate for Payer: Humana KY Medicaid |
$4,045.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,086.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,646.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,126.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,352.63
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.95
|
| Rate for Payer: PHCS Commercial |
$11,293.78
|
| Rate for Payer: United Healthcare All Payer |
$10,352.63
|
|
|
PROMODEL ORTHOBIOLOGC IMPT 5CC
|
Facility
|
IP
|
$7,063.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.22 |
| Max. Negotiated Rate |
$6,780.67 |
| Rate for Payer: Aetna Commercial |
$5,438.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,509.30
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,862.46
|
| Rate for Payer: First Health Commercial |
$6,710.04
|
| Rate for Payer: Humana Commercial |
$6,003.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,791.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,212.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,215.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,297.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.59
|
| Rate for Payer: PHCS Commercial |
$6,780.67
|
| Rate for Payer: United Healthcare All Payer |
$6,215.62
|
|
|
PROMODEL ORTHOBIOLOGC IMPT 5CC
|
Facility
|
OP
|
$7,063.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.22 |
| Max. Negotiated Rate |
$6,780.67 |
| Rate for Payer: Aetna Commercial |
$5,438.66
|
| Rate for Payer: Anthem Medicaid |
$2,429.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,509.30
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,862.46
|
| Rate for Payer: First Health Commercial |
$6,710.04
|
| Rate for Payer: Humana Commercial |
$6,003.72
|
| Rate for Payer: Humana KY Medicaid |
$2,429.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,453.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,791.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,212.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,477.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,215.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,297.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.59
|
| Rate for Payer: PHCS Commercial |
$6,780.67
|
| Rate for Payer: United Healthcare All Payer |
$6,215.62
|
|
|
PROMODEL ORTHOBIOLOGC INJ 10CC
|
Facility
|
IP
|
$11,764.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.37 |
| Max. Negotiated Rate |
$11,293.78 |
| Rate for Payer: Aetna Commercial |
$9,058.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.19
|
| Rate for Payer: Cash Price |
$5,882.18
|
| Rate for Payer: Cigna Commercial |
$9,764.41
|
| Rate for Payer: First Health Commercial |
$11,176.13
|
| Rate for Payer: Humana Commercial |
$9,999.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,646.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,352.63
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.95
|
| Rate for Payer: PHCS Commercial |
$11,293.78
|
| Rate for Payer: United Healthcare All Payer |
$10,352.63
|
|
|
PROMODEL ORTHOBIOLOGC INJ 10CC
|
Facility
|
OP
|
$11,764.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.37 |
| Max. Negotiated Rate |
$11,293.78 |
| Rate for Payer: Aetna Commercial |
$9,058.55
|
| Rate for Payer: Anthem Medicaid |
$4,045.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.19
|
| Rate for Payer: Cash Price |
$5,882.18
|
| Rate for Payer: Cigna Commercial |
$9,764.41
|
| Rate for Payer: First Health Commercial |
$11,176.13
|
| Rate for Payer: Humana Commercial |
$9,999.70
|
| Rate for Payer: Humana KY Medicaid |
$4,045.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,086.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,646.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,126.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,352.63
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.95
|
| Rate for Payer: PHCS Commercial |
$11,293.78
|
| Rate for Payer: United Healthcare All Payer |
$10,352.63
|
|
|
PROMODEL ORTHOBIOLOGIC INJ 5CC
|
Facility
|
OP
|
$7,063.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.22 |
| Max. Negotiated Rate |
$6,780.67 |
| Rate for Payer: Aetna Commercial |
$5,438.66
|
| Rate for Payer: Anthem Medicaid |
$2,429.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,509.30
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,862.46
|
| Rate for Payer: First Health Commercial |
$6,710.04
|
| Rate for Payer: Humana Commercial |
$6,003.72
|
| Rate for Payer: Humana KY Medicaid |
$2,429.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,453.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,791.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,212.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,477.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,215.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,297.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.59
|
| Rate for Payer: PHCS Commercial |
$6,780.67
|
| Rate for Payer: United Healthcare All Payer |
$6,215.62
|
|
|
PROMODEL ORTHOBIOLOGIC INJ 5CC
|
Facility
|
IP
|
$7,063.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.22 |
| Max. Negotiated Rate |
$6,780.67 |
| Rate for Payer: Aetna Commercial |
$5,438.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,509.30
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,862.46
|
| Rate for Payer: First Health Commercial |
$6,710.04
|
| Rate for Payer: Humana Commercial |
$6,003.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,791.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,212.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,215.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,297.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.59
|
| Rate for Payer: PHCS Commercial |
$6,780.67
|
| Rate for Payer: United Healthcare All Payer |
$6,215.62
|
|
|
PROMOS HUM STEM CEMENTLESS
|
Facility
|
OP
|
$9,497.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,234.71 |
| Max. Negotiated Rate |
$9,117.84 |
| Rate for Payer: Aetna Commercial |
$7,313.27
|
| Rate for Payer: Anthem Medicaid |
$3,266.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,408.24
|
| Rate for Payer: Cash Price |
$4,748.88
|
| Rate for Payer: Cigna Commercial |
$7,883.13
|
| Rate for Payer: First Health Commercial |
$9,022.86
|
| Rate for Payer: Humana Commercial |
$8,073.09
|
| Rate for Payer: Humana KY Medicaid |
$3,266.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,788.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,009.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,358.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,123.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,899.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,234.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,944.30
|
| Rate for Payer: PHCS Commercial |
$9,117.84
|
| Rate for Payer: United Healthcare All Payer |
$8,358.02
|
|
|
PROMOS HUM STEM CEMENTLESS
|
Facility
|
IP
|
$9,497.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,234.71 |
| Max. Negotiated Rate |
$9,117.84 |
| Rate for Payer: Aetna Commercial |
$7,313.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,408.24
|
| Rate for Payer: Cash Price |
$4,748.88
|
| Rate for Payer: Cigna Commercial |
$7,883.13
|
| Rate for Payer: First Health Commercial |
$9,022.86
|
| Rate for Payer: Humana Commercial |
$8,073.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,788.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,009.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,358.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,123.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,899.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,234.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,944.30
|
| Rate for Payer: PHCS Commercial |
$9,117.84
|
| Rate for Payer: United Healthcare All Payer |
$8,358.02
|
|
|
PRONESTYL 1000MG/10ML VIAL
|
Facility
|
IP
|
$361.06
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
25002325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$346.62 |
| Rate for Payer: Aetna Commercial |
$278.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.63
|
| Rate for Payer: Cash Price |
$180.53
|
| Rate for Payer: Cigna Commercial |
$299.68
|
| Rate for Payer: First Health Commercial |
$343.01
|
| Rate for Payer: Humana Commercial |
$306.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.73
|
| Rate for Payer: Ohio Health Group HMO |
$270.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.93
|
| Rate for Payer: PHCS Commercial |
$346.62
|
| Rate for Payer: United Healthcare All Payer |
$317.73
|
|
|
PRONESTYL 1000MG/10ML VIAL
|
Facility
|
OP
|
$361.06
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
25002325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$346.62 |
| Rate for Payer: Anthem Medicaid |
$124.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$146.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.53
|
| Rate for Payer: Cash Price |
$180.53
|
| Rate for Payer: Cash Price |
$180.53
|
| Rate for Payer: Cigna Commercial |
$299.68
|
| Rate for Payer: First Health Commercial |
$343.01
|
| Rate for Payer: Humana Commercial |
$306.90
|
| Rate for Payer: Humana KY Medicaid |
$124.17
|
| Rate for Payer: Humana Medicare Advantage |
$146.32
|
| Rate for Payer: Kentucky WC Medicaid |
$125.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.73
|
| Rate for Payer: Ohio Health Group HMO |
$270.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.93
|
| Rate for Payer: PHCS Commercial |
$346.62
|
| Rate for Payer: United Healthcare All Payer |
$317.73
|
| Rate for Payer: Aetna Commercial |
$278.02
|
|
|
PRONOX
|
Professional
|
Both
|
$40.00
|
|
| Hospital Charge Code |
22200206
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
|
|
PROPEL MOMETASONE FUROATE IMP
|
Facility
|
OP
|
$6,519.35
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.52 |
| Max. Negotiated Rate |
$6,258.58 |
| Rate for Payer: Aetna Commercial |
$5,019.90
|
| Rate for Payer: Anthem Medicaid |
$2,242.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,085.09
|
| Rate for Payer: Cash Price |
$3,259.68
|
| Rate for Payer: Cigna Commercial |
$5,411.06
|
| Rate for Payer: First Health Commercial |
$6,193.38
|
| Rate for Payer: Humana Commercial |
$5,541.45
|
| Rate for Payer: Humana KY Medicaid |
$2,242.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,264.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,345.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,811.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,955.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,737.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,889.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.00
|
| Rate for Payer: PHCS Commercial |
$6,258.58
|
| Rate for Payer: United Healthcare All Payer |
$5,737.03
|
|
|
PROPEL MOMETASONE FUROATE IMP
|
Facility
|
IP
|
$6,519.35
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.52 |
| Max. Negotiated Rate |
$6,258.58 |
| Rate for Payer: Aetna Commercial |
$5,019.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,085.09
|
| Rate for Payer: Cash Price |
$3,259.68
|
| Rate for Payer: Cigna Commercial |
$5,411.06
|
| Rate for Payer: First Health Commercial |
$6,193.38
|
| Rate for Payer: Humana Commercial |
$5,541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,345.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,811.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,955.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,737.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,889.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.00
|
| Rate for Payer: PHCS Commercial |
$6,258.58
|
| Rate for Payer: United Healthcare All Payer |
$5,737.03
|
|
|
PROPYLTHIOURACIL 50 50MG/1TAB
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 480924201
|
| Hospital Charge Code |
25001257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROPYLTHIOURACIL 50 50MG/1TAB
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 480924201
|
| Hospital Charge Code |
25001257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROSCAR (FINASTERIDE) 5MG/1TAB
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 31722052590
|
| Hospital Charge Code |
25001258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PROSCAR (FINASTERIDE) 5MG/1TAB
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 31722052590
|
| Hospital Charge Code |
25001258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PROSTALAC ACETABULAR CUP 42*32
|
Facility
|
IP
|
$8,030.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,043.96 |
| Max. Negotiated Rate |
$7,709.23 |
| Rate for Payer: Aetna Commercial |
$6,183.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,263.75
|
| Rate for Payer: Cash Price |
$4,015.22
|
| Rate for Payer: Cigna Commercial |
$6,665.27
|
| Rate for Payer: First Health Commercial |
$7,628.93
|
| Rate for Payer: Humana Commercial |
$6,825.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,584.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,066.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,022.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.44
|
| Rate for Payer: PHCS Commercial |
$7,709.23
|
| Rate for Payer: United Healthcare All Payer |
$7,066.80
|
|
|
PROSTALAC ACETABULAR CUP 42*32
|
Facility
|
OP
|
$8,030.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,043.96 |
| Max. Negotiated Rate |
$7,709.23 |
| Rate for Payer: Aetna Commercial |
$6,183.45
|
| Rate for Payer: Anthem Medicaid |
$2,761.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,263.75
|
| Rate for Payer: Cash Price |
$4,015.22
|
| Rate for Payer: Cigna Commercial |
$6,665.27
|
| Rate for Payer: First Health Commercial |
$7,628.93
|
| Rate for Payer: Humana Commercial |
$6,825.88
|
| Rate for Payer: Humana KY Medicaid |
$2,761.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,789.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,584.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,926.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,817.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,066.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,022.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,489.44
|
| Rate for Payer: PHCS Commercial |
$7,709.23
|
| Rate for Payer: United Healthcare All Payer |
$7,066.80
|
|
|
PROSTALAC HIP STEM SZ3 200MM L
|
Facility
|
IP
|
$26,437.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,436.84 |
| Max. Negotiated Rate |
$25,379.71 |
| Rate for Payer: Aetna Commercial |
$20,356.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,621.02
|
| Rate for Payer: Cash Price |
$13,218.60
|
| Rate for Payer: Cigna Commercial |
$21,942.88
|
| Rate for Payer: First Health Commercial |
$25,115.34
|
| Rate for Payer: Humana Commercial |
$22,471.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,678.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,510.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,931.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,264.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,827.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,287.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,195.53
|
| Rate for Payer: PHCS Commercial |
$25,379.71
|
| Rate for Payer: United Healthcare All Payer |
$23,264.74
|
|
|
PROSTALAC HIP STEM SZ3 200MM L
|
Facility
|
OP
|
$26,437.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,436.84 |
| Max. Negotiated Rate |
$25,379.71 |
| Rate for Payer: Aetna Commercial |
$20,356.64
|
| Rate for Payer: Anthem Medicaid |
$9,091.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,621.02
|
| Rate for Payer: Cash Price |
$13,218.60
|
| Rate for Payer: Cigna Commercial |
$21,942.88
|
| Rate for Payer: First Health Commercial |
$25,115.34
|
| Rate for Payer: Humana Commercial |
$22,471.62
|
| Rate for Payer: Humana KY Medicaid |
$9,091.75
|
| Rate for Payer: Kentucky WC Medicaid |
$9,184.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,678.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,510.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,931.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,274.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,264.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,827.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,287.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,195.53
|
| Rate for Payer: PHCS Commercial |
$25,379.71
|
| Rate for Payer: United Healthcare All Payer |
$23,264.74
|
|
|
PROSTALAC HIP STEM SZ3 200MM R
|
Facility
|
IP
|
$32,050.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.62 |
| Max. Negotiated Rate |
$30,768.86 |
| Rate for Payer: Aetna Commercial |
$24,679.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,999.70
|
| Rate for Payer: Cash Price |
$16,025.45
|
| Rate for Payer: Cigna Commercial |
$26,602.25
|
| Rate for Payer: First Health Commercial |
$30,448.36
|
| Rate for Payer: Humana Commercial |
$27,243.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,281.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,653.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,615.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,204.79
|
| Rate for Payer: Ohio Health Group HMO |
$24,038.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,410.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,935.78
|
| Rate for Payer: PHCS Commercial |
$30,768.86
|
| Rate for Payer: United Healthcare All Payer |
$28,204.79
|
|
|
PROSTALAC HIP STEM SZ3 200MM R
|
Facility
|
OP
|
$32,050.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.62 |
| Max. Negotiated Rate |
$30,768.86 |
| Rate for Payer: Aetna Commercial |
$24,679.19
|
| Rate for Payer: Anthem Medicaid |
$11,022.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,999.70
|
| Rate for Payer: Cash Price |
$16,025.45
|
| Rate for Payer: Cigna Commercial |
$26,602.25
|
| Rate for Payer: First Health Commercial |
$30,448.36
|
| Rate for Payer: Humana Commercial |
$27,243.26
|
| Rate for Payer: Humana KY Medicaid |
$11,022.30
|
| Rate for Payer: Kentucky WC Medicaid |
$11,134.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,281.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,653.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,615.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,243.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,204.79
|
| Rate for Payer: Ohio Health Group HMO |
$24,038.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,410.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,935.78
|
| Rate for Payer: PHCS Commercial |
$30,768.86
|
| Rate for Payer: United Healthcare All Payer |
$28,204.79
|
|
|
PROSTAR XL 10FR
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
