|
PROBE KIT 20MM SINGLE
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
PROBE KIT 20MM X2 DUAL
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PROBE KIT 20MM X2 DUAL
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PROBE KIT 7MM SINGLE
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
PROBE KIT 7MM SINGLE
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
PROBE KIT 7MM X2 DUAL
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PROBE KIT 7MM X2 DUAL
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PROBE SHEATH F/UM-BS20-26R
|
Facility
|
IP
|
$2,042.37
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.71 |
| Max. Negotiated Rate |
$1,960.68 |
| Rate for Payer: Aetna Commercial |
$1,572.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,593.05
|
| Rate for Payer: Cash Price |
$1,021.18
|
| Rate for Payer: Cigna Commercial |
$1,695.17
|
| Rate for Payer: First Health Commercial |
$1,940.25
|
| Rate for Payer: Humana Commercial |
$1,736.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,507.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,797.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.24
|
| Rate for Payer: PHCS Commercial |
$1,960.68
|
| Rate for Payer: United Healthcare All Payer |
$1,797.29
|
|
|
PROBE SHEATH F/UM-BS20-26R
|
Facility
|
OP
|
$2,042.37
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.71 |
| Max. Negotiated Rate |
$1,960.68 |
| Rate for Payer: Aetna Commercial |
$1,572.62
|
| Rate for Payer: Anthem Medicaid |
$702.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,593.05
|
| Rate for Payer: Cash Price |
$1,021.18
|
| Rate for Payer: Cigna Commercial |
$1,695.17
|
| Rate for Payer: First Health Commercial |
$1,940.25
|
| Rate for Payer: Humana Commercial |
$1,736.01
|
| Rate for Payer: Humana KY Medicaid |
$702.37
|
| Rate for Payer: Kentucky WC Medicaid |
$709.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,507.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,797.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.24
|
| Rate for Payer: PHCS Commercial |
$1,960.68
|
| Rate for Payer: United Healthcare All Payer |
$1,797.29
|
|
|
PROCALCITONIN
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.37
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
PROCALCITONIN
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem Medicaid |
$27.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.22
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Humana KY Medicaid |
$27.22
|
| Rate for Payer: Humana Medicare Advantage |
$27.22
|
| Rate for Payer: Kentucky WC Medicaid |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
PROCALCITONIN
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$154.20 |
| Rate for Payer: Aetna Commercial |
$44.44
|
| Rate for Payer: Ambetter Exchange |
$27.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.66
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.22
|
| Rate for Payer: Multiplan PHCS |
$154.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.39
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.22
|
|
|
PROCARDIA (NIFEDIPIN 10MG/1CAP
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 69315021101
|
| Hospital Charge Code |
25001242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PROCARDIA (NIFEDIPIN 10MG/1CAP
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 69315021101
|
| Hospital Charge Code |
25001242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PROCARDIA XL (NIFEDI 90MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 50742026201
|
| Hospital Charge Code |
25001243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
PROCARDIA XL (NIFEDI 90MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 50742026201
|
| Hospital Charge Code |
25001243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
PROCARDIA XL(NIFEDIP 30MG/1TAB
|
Facility
|
OP
|
$9.49
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
25001244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem Medicaid |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Humana KY Medicaid |
$3.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
|
|
PROCARDIA XL(NIFEDIP 30MG/1TAB
|
Facility
|
IP
|
$9.49
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
25001244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
|
|
PROCARDIA XL(NIFEDIP 60MG/1TAB
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 67877075801
|
| Hospital Charge Code |
25001245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
PROCARDIA XL(NIFEDIP 60MG/1TAB
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 67877075801
|
| Hospital Charge Code |
25001245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
PROCRIT 1000U 10000U/ML VIAL
|
Facility
|
OP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$1,398.20 |
| Rate for Payer: Aetna Commercial |
$1,121.47
|
| Rate for Payer: Anthem Medicaid |
$500.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.37
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cigna Commercial |
$1,208.86
|
| Rate for Payer: First Health Commercial |
$1,383.64
|
| Rate for Payer: Humana Commercial |
$1,237.99
|
| Rate for Payer: Humana KY Medicaid |
$500.88
|
| Rate for Payer: Humana Medicare Advantage |
$7.68
|
| Rate for Payer: Kentucky WC Medicaid |
$505.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$510.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.96
|
| Rate for Payer: PHCS Commercial |
$1,398.20
|
| Rate for Payer: United Healthcare All Payer |
$1,281.68
|
|
|
PROCRIT 1000U 10000U/ML VIAL
|
Facility
|
IP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$436.94 |
| Max. Negotiated Rate |
$1,398.20 |
| Rate for Payer: Aetna Commercial |
$1,121.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.04
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cigna Commercial |
$1,208.86
|
| Rate for Payer: First Health Commercial |
$1,383.64
|
| Rate for Payer: Humana Commercial |
$1,237.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$436.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.96
|
| Rate for Payer: PHCS Commercial |
$1,398.20
|
| Rate for Payer: United Healthcare All Payer |
$1,281.68
|
|
|
PROCRIT 1000 UN (40000 UN VL)
|
Facility
|
IP
|
$5,826.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,747.82 |
| Max. Negotiated Rate |
$5,593.01 |
| Rate for Payer: Aetna Commercial |
$4,486.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.32
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cigna Commercial |
$4,835.62
|
| Rate for Payer: First Health Commercial |
$5,534.75
|
| Rate for Payer: Humana Commercial |
$4,952.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,747.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,126.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,660.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,068.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,019.97
|
| Rate for Payer: PHCS Commercial |
$5,593.01
|
| Rate for Payer: United Healthcare All Payer |
$5,126.92
|
|
|
PROCRIT 1000 UN (40000 UN VL)
|
Facility
|
OP
|
$5,826.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$5,593.01 |
| Rate for Payer: Aetna Commercial |
$4,486.06
|
| Rate for Payer: Anthem Medicaid |
$2,003.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.37
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cigna Commercial |
$4,835.62
|
| Rate for Payer: First Health Commercial |
$5,534.75
|
| Rate for Payer: Humana Commercial |
$4,952.14
|
| Rate for Payer: Humana KY Medicaid |
$2,003.58
|
| Rate for Payer: Humana Medicare Advantage |
$7.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,023.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,043.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,126.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,660.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,068.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,019.97
|
| Rate for Payer: PHCS Commercial |
$5,593.01
|
| Rate for Payer: United Healthcare All Payer |
$5,126.92
|
|
|
PROCRIT1000UNIT[4000UNIT/ML VL
|
Facility
|
OP
|
$582.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem Medicaid |
$200.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.37
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$483.57
|
| Rate for Payer: First Health Commercial |
$553.48
|
| Rate for Payer: Humana Commercial |
$495.22
|
| Rate for Payer: Humana KY Medicaid |
$200.36
|
| Rate for Payer: Humana Medicare Advantage |
$7.68
|
| Rate for Payer: Kentucky WC Medicaid |
$202.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.70
|
| Rate for Payer: Ohio Health Group HMO |
$436.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$466.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$402.00
|
| Rate for Payer: PHCS Commercial |
$559.31
|
| Rate for Payer: United Healthcare All Payer |
$512.70
|
|
