|
PROSTAR XL 10FR
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PROSTATE BIOPSY 1-20 SPECIMENS
|
Facility
|
OP
|
$3,027.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001552
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$310.83 |
| Max. Negotiated Rate |
$2,905.92 |
| Rate for Payer: Aetna Commercial |
$2,330.79
|
| Rate for Payer: Anthem Medicaid |
$1,040.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,430.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$1,513.50
|
| Rate for Payer: Cash Price |
$1,513.50
|
| Rate for Payer: Cigna Commercial |
$2,512.41
|
| Rate for Payer: First Health Commercial |
$2,875.65
|
| Rate for Payer: Humana Commercial |
$2,572.95
|
| Rate for Payer: Humana KY Medicaid |
$1,040.99
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,051.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,482.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,233.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,061.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,663.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,270.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$605.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$938.37
|
| Rate for Payer: PHCS Commercial |
$2,905.92
|
| Rate for Payer: United Healthcare All Payer |
$2,663.76
|
|
|
PROSTATE BIOPSY 1-20 SPECIMENS
|
Facility
|
IP
|
$3,027.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001552
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$393.51 |
| Max. Negotiated Rate |
$2,905.92 |
| Rate for Payer: Aetna Commercial |
$2,330.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,430.68
|
| Rate for Payer: Cash Price |
$1,513.50
|
| Rate for Payer: Cigna Commercial |
$2,512.41
|
| Rate for Payer: First Health Commercial |
$2,875.65
|
| Rate for Payer: Humana Commercial |
$2,572.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,482.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,233.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$908.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,663.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,270.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$605.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$938.37
|
| Rate for Payer: PHCS Commercial |
$2,905.92
|
| Rate for Payer: United Healthcare All Payer |
$2,663.76
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$963.98 |
| Rate for Payer: Aetna Commercial |
$963.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$907.00
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.07
|
| Rate for Payer: Multiplan PHCS |
$544.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.90
|
| Rate for Payer: UHCCP Medicaid |
$317.45
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.91 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem Medicaid |
$311.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Humana KY Medicaid |
$311.92
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$315.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.91 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.32
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
PROSTATECTOMY (TURP)
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.31 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,343.79
|
| Rate for Payer: Anthem Medicaid |
$684.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,183.14
|
| Rate for Payer: Healthspan PPO |
$1,074.48
|
| Rate for Payer: Humana Medicaid |
$684.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,140.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.00
|
| Rate for Payer: Molina Healthcare Passport |
$684.31
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.15
|
|
|
PROSTATECTOMY (TURP)
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
PROSTATECTOMY (TURP)
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
PROSTATECTOMY (TURP)(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
761P2113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.31 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,343.79
|
| Rate for Payer: Anthem Medicaid |
$684.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,183.14
|
| Rate for Payer: Healthspan PPO |
$1,074.48
|
| Rate for Payer: Humana Medicaid |
$684.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,140.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.00
|
| Rate for Payer: Molina Healthcare Passport |
$684.31
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.15
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$20,090.49
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$13,632.83 |
| Max. Negotiated Rate |
$20,090.49 |
| Rate for Payer: Anthem Medicaid |
$13,632.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,350.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,090.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,372.97
|
| Rate for Payer: Humana KY Medicaid |
$13,632.83
|
| Rate for Payer: Humana Medicare Advantage |
$14,350.35
|
| Rate for Payer: Kentucky WC Medicaid |
$13,769.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,220.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,905.49
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$36,136.93
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$24,521.49 |
| Max. Negotiated Rate |
$36,136.93 |
| Rate for Payer: Anthem Medicaid |
$24,521.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,812.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36,136.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$34,846.32
|
| Rate for Payer: Humana KY Medicaid |
$24,521.49
|
| Rate for Payer: Humana Medicare Advantage |
$25,812.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24,766.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,974.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,011.92
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$12,278.43
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$8,331.79 |
| Max. Negotiated Rate |
$12,278.43 |
| Rate for Payer: Anthem Medicaid |
$8,331.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,770.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,278.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,839.92
|
| Rate for Payer: Humana KY Medicaid |
$8,331.79
|
| Rate for Payer: Humana Medicare Advantage |
$8,770.31
|
| Rate for Payer: Kentucky WC Medicaid |
$8,415.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,524.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,498.43
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
43000032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
43000032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTIGMINE 0.5 MG (10MG/10ML)
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
PROSTIGMINE 0.5 MG (10MG/10ML)
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.18
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
PROSTIGMINE 0.5 MG [2 MG SYR]
|
Facility
|
OP
|
$79.67
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Aetna Commercial |
$61.35
|
| Rate for Payer: Anthem Medicaid |
$27.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.14
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.13
|
| Rate for Payer: First Health Commercial |
$75.69
|
| Rate for Payer: Humana Commercial |
$67.72
|
| Rate for Payer: Humana KY Medicaid |
$27.40
|
| Rate for Payer: Kentucky WC Medicaid |
$27.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.11
|
| Rate for Payer: Ohio Health Group HMO |
$59.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.70
|
| Rate for Payer: PHCS Commercial |
$76.48
|
| Rate for Payer: United Healthcare All Payer |
$70.11
|
|
|
PROSTIGMINE 0.5 MG [2 MG SYR]
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Aetna Commercial |
$61.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.14
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.13
|
| Rate for Payer: First Health Commercial |
$75.69
|
| Rate for Payer: Humana Commercial |
$67.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.11
|
| Rate for Payer: Ohio Health Group HMO |
$59.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.70
|
| Rate for Payer: PHCS Commercial |
$76.48
|
| Rate for Payer: United Healthcare All Payer |
$70.11
|
|
|
PROSTIGMINE(NEOSTIG)0.5 MG
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$62.25
|
| Rate for Payer: Kentucky WC Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PROSTIGMINE(NEOSTIG)0.5 MG
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PROSTIN VR PED (ALP 500MCG/1ML
|
Facility
|
IP
|
$837.12
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25001851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$803.64 |
| Rate for Payer: Aetna Commercial |
$644.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.95
|
| Rate for Payer: Cash Price |
$418.56
|
| Rate for Payer: Cigna Commercial |
$694.81
|
| Rate for Payer: First Health Commercial |
$795.26
|
| Rate for Payer: Humana Commercial |
$711.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.67
|
| Rate for Payer: Ohio Health Group HMO |
$627.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.51
|
| Rate for Payer: PHCS Commercial |
$803.64
|
| Rate for Payer: United Healthcare All Payer |
$736.67
|
|
|
PROSTIN VR PED (ALP 500MCG/1ML
|
Facility
|
OP
|
$837.12
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25001851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$803.64 |
| Rate for Payer: Aetna Commercial |
$644.58
|
| Rate for Payer: Anthem Medicaid |
$287.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.95
|
| Rate for Payer: Cash Price |
$418.56
|
| Rate for Payer: Cigna Commercial |
$694.81
|
| Rate for Payer: First Health Commercial |
$795.26
|
| Rate for Payer: Humana Commercial |
$711.55
|
| Rate for Payer: Humana KY Medicaid |
$287.89
|
| Rate for Payer: Kentucky WC Medicaid |
$290.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.67
|
| Rate for Payer: Ohio Health Group HMO |
$627.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.51
|
| Rate for Payer: PHCS Commercial |
$803.64
|
| Rate for Payer: United Healthcare All Payer |
$736.67
|
|
