|
PROCRIT1000UNIT[4000UNIT/ML VL
|
Facility
|
IP
|
$582.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.78 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| 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: 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 |
$174.78
|
| 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
|
|
|
PROCRIT 100U(10KUSDV)(ONHD)
|
Facility
|
OP
|
$1,456.51
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004224
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$436.95 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: Aetna Commercial |
$1,121.51
|
| Rate for Payer: Anthem Medicaid |
$500.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.08
|
| Rate for Payer: Cash Price |
$728.26
|
| Rate for Payer: Cigna Commercial |
$1,208.90
|
| Rate for Payer: First Health Commercial |
$1,383.68
|
| Rate for Payer: Humana Commercial |
$1,238.03
|
| Rate for Payer: Humana KY Medicaid |
$500.89
|
| Rate for Payer: Kentucky WC Medicaid |
$505.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$436.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$510.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.99
|
| Rate for Payer: PHCS Commercial |
$1,398.25
|
| Rate for Payer: United Healthcare All Payer |
$1,281.73
|
|
|
PROCRIT 100U(10KUSDV)(ONHD)
|
Facility
|
IP
|
$1,456.51
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004224
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$436.95 |
| Max. Negotiated Rate |
$1,398.25 |
| Rate for Payer: Aetna Commercial |
$1,121.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.08
|
| Rate for Payer: Cash Price |
$728.26
|
| Rate for Payer: Cigna Commercial |
$1,208.90
|
| Rate for Payer: First Health Commercial |
$1,383.68
|
| Rate for Payer: Humana Commercial |
$1,238.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$436.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.99
|
| Rate for Payer: PHCS Commercial |
$1,398.25
|
| Rate for Payer: United Healthcare All Payer |
$1,281.73
|
|
|
PROCRIT 100U(2KU SDV)(ONHD)
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004221
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$279.71 |
| Rate for Payer: Aetna Commercial |
$224.35
|
| Rate for Payer: Anthem Medicaid |
$100.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.26
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cigna Commercial |
$241.83
|
| Rate for Payer: First Health Commercial |
$276.79
|
| Rate for Payer: Humana Commercial |
$247.66
|
| Rate for Payer: Humana KY Medicaid |
$100.20
|
| Rate for Payer: Kentucky WC Medicaid |
$101.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.40
|
| Rate for Payer: Ohio Health Group HMO |
$218.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.04
|
| Rate for Payer: PHCS Commercial |
$279.71
|
| Rate for Payer: United Healthcare All Payer |
$256.40
|
|
|
PROCRIT 100U(2KU SDV)(ONHD)
|
Facility
|
IP
|
$291.36
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004221
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$279.71 |
| Rate for Payer: Aetna Commercial |
$224.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.26
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cigna Commercial |
$241.83
|
| Rate for Payer: First Health Commercial |
$276.79
|
| Rate for Payer: Humana Commercial |
$247.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.40
|
| Rate for Payer: Ohio Health Group HMO |
$218.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.04
|
| Rate for Payer: PHCS Commercial |
$279.71
|
| Rate for Payer: United Healthcare All Payer |
$256.40
|
|
|
PROCRIT 100U(3KU SDV)(ONHD)
|
Facility
|
OP
|
$436.98
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004222
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$131.09 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Aetna Commercial |
$336.47
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.84
|
| Rate for Payer: Cash Price |
$218.49
|
| Rate for Payer: Cigna Commercial |
$362.69
|
| Rate for Payer: First Health Commercial |
$415.13
|
| Rate for Payer: Humana Commercial |
$371.43
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.54
|
| Rate for Payer: Ohio Health Group HMO |
$327.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.52
|
| Rate for Payer: PHCS Commercial |
$419.50
|
| Rate for Payer: United Healthcare All Payer |
$384.54
|
|
|
PROCRIT 100U(3KU SDV)(ONHD)
|
Facility
|
IP
|
$436.98
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004222
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$131.09 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Aetna Commercial |
$336.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.84
|
| Rate for Payer: Cash Price |
$218.49
|
| Rate for Payer: Cigna Commercial |
$362.69
|
| Rate for Payer: First Health Commercial |
$415.13
|
| Rate for Payer: Humana Commercial |
$371.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.54
|
| Rate for Payer: Ohio Health Group HMO |
$327.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.52
|
| Rate for Payer: PHCS Commercial |
$419.50
|
| Rate for Payer: United Healthcare All Payer |
$384.54
|
|
|
PROCRIT 100U(40KUSDV)(ONHD)
|
Facility
|
OP
|
$5,826.05
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004225
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$1,747.82 |
| 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 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: Humana KY Medicaid |
$2,003.58
|
| 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 |
$1,747.82
|
| 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
|
|
|
PROCRIT 100U(40KUSDV)(ONHD)
|
Facility
|
IP
|
$5,826.05
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004225
|
|
Hospital Revenue Code
|
635
|
| 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 100U(4KU SDV)(ONHD)
|
Facility
|
IP
|
$582.61
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004223
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$174.78 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| 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: 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 |
$174.78
|
| 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
|
|
|
PROCRIT 100U(4KU SDV)(ONHD)
|
Facility
|
OP
|
$582.61
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25004223
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$174.78 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem Medicaid |
$200.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| 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: 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 |
$174.78
|
| 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
|
|
|
PROCRIT 1KU(20KU MDV)(NONESRD)
|
Facility
|
OP
|
$145.68
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25004214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$139.85 |
| Rate for Payer: Aetna Commercial |
$112.17
|
| Rate for Payer: Anthem Medicaid |
$50.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.37
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cigna Commercial |
$120.91
|
| Rate for Payer: First Health Commercial |
$138.40
|
| Rate for Payer: Humana Commercial |
$123.83
|
| Rate for Payer: Humana KY Medicaid |
$50.10
|
| Rate for Payer: Humana Medicare Advantage |
$7.68
|
| Rate for Payer: Kentucky WC Medicaid |
$50.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.20
|
| Rate for Payer: Ohio Health Group HMO |
$109.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.52
|
| Rate for Payer: PHCS Commercial |
$139.85
|
| Rate for Payer: United Healthcare All Payer |
$128.20
|
|
|
PROCRIT 1KU(20KU MDV)(NONESRD)
|
Facility
|
IP
|
$145.68
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25004214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$139.85 |
| Rate for Payer: Aetna Commercial |
$112.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.63
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cigna Commercial |
$120.91
|
| Rate for Payer: First Health Commercial |
$138.40
|
| Rate for Payer: Humana Commercial |
$123.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.20
|
| Rate for Payer: Ohio Health Group HMO |
$109.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.52
|
| Rate for Payer: PHCS Commercial |
$139.85
|
| Rate for Payer: United Healthcare All Payer |
$128.20
|
|
|
PROCRIT 2000UNIT/ML VIAL
|
Facility
|
IP
|
$291.36
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$279.71 |
| Rate for Payer: Aetna Commercial |
$224.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.26
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cigna Commercial |
$241.83
|
| Rate for Payer: First Health Commercial |
$276.79
|
| Rate for Payer: Humana Commercial |
$247.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.40
|
| Rate for Payer: Ohio Health Group HMO |
$218.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.04
|
| Rate for Payer: PHCS Commercial |
$279.71
|
| Rate for Payer: United Healthcare All Payer |
$256.40
|
|
|
PROCRIT 2000UNIT/ML VIAL
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$279.71 |
| Rate for Payer: Aetna Commercial |
$224.35
|
| Rate for Payer: Anthem Medicaid |
$100.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.37
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cigna Commercial |
$241.83
|
| Rate for Payer: First Health Commercial |
$276.79
|
| Rate for Payer: Humana Commercial |
$247.66
|
| Rate for Payer: Humana KY Medicaid |
$100.20
|
| Rate for Payer: Humana Medicare Advantage |
$7.68
|
| Rate for Payer: Kentucky WC Medicaid |
$101.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.40
|
| Rate for Payer: Ohio Health Group HMO |
$218.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.04
|
| Rate for Payer: PHCS Commercial |
$279.71
|
| Rate for Payer: United Healthcare All Payer |
$256.40
|
|
|
PROCRIT (DIALYSIS) INJECTION
|
Facility
|
IP
|
$2,913.03
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25002719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$873.91 |
| Max. Negotiated Rate |
$2,796.51 |
| Rate for Payer: Aetna Commercial |
$2,243.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,272.16
|
| Rate for Payer: Cash Price |
$1,456.52
|
| Rate for Payer: Cigna Commercial |
$2,417.81
|
| Rate for Payer: First Health Commercial |
$2,767.38
|
| Rate for Payer: Humana Commercial |
$2,476.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$873.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,563.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,330.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,534.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.99
|
| Rate for Payer: PHCS Commercial |
$2,796.51
|
| Rate for Payer: United Healthcare All Payer |
$2,563.47
|
|
|
PROCRIT (DIALYSIS) INJECTION
|
Facility
|
OP
|
$2,913.03
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
25002719
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$873.91 |
| Max. Negotiated Rate |
$2,796.51 |
| Rate for Payer: Aetna Commercial |
$2,243.03
|
| Rate for Payer: Anthem Medicaid |
$1,001.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,272.16
|
| Rate for Payer: Cash Price |
$1,456.52
|
| Rate for Payer: Cigna Commercial |
$2,417.81
|
| Rate for Payer: First Health Commercial |
$2,767.38
|
| Rate for Payer: Humana Commercial |
$2,476.08
|
| Rate for Payer: Humana KY Medicaid |
$1,001.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,011.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$873.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,021.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,563.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,330.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,534.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.99
|
| Rate for Payer: PHCS Commercial |
$2,796.51
|
| Rate for Payer: United Healthcare All Payer |
$2,563.47
|
|
|
PROCTECTOMY - COMPLETE
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 45110
|
| Hospital Charge Code |
76101877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,157.25 |
| Max. Negotiated Rate |
$2,664.45 |
| Rate for Payer: Aetna Commercial |
$2,664.45
|
| Rate for Payer: Ambetter Exchange |
$1,706.68
|
| Rate for Payer: Anthem Medicaid |
$1,157.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,706.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,706.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,048.02
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,491.13
|
| Rate for Payer: Healthspan PPO |
$2,246.98
|
| Rate for Payer: Humana Medicaid |
$1,157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,352.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,706.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,180.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,157.25
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,218.68
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,168.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,706.68
|
|
|
PROCTECTOMY - COMPLETE
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 45110
|
| Hospital Charge Code |
76101877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| 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 |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PROCTECTOMY - COMPLETE
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 45110
|
| Hospital Charge Code |
76101877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| 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 |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PROCTECTOMY - COMPLETE(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 45110
|
| Hospital Charge Code |
761P1877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,157.25 |
| Max. Negotiated Rate |
$2,664.45 |
| Rate for Payer: Aetna Commercial |
$2,664.45
|
| Rate for Payer: Ambetter Exchange |
$1,706.68
|
| Rate for Payer: Anthem Medicaid |
$1,157.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,706.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,706.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,048.02
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,491.13
|
| Rate for Payer: Healthspan PPO |
$2,246.98
|
| Rate for Payer: Humana Medicaid |
$1,157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,352.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,706.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,180.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,157.25
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,218.68
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,168.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,706.68
|
|
|
PROCTOFOAM-HC (PRAMOXINE/ 10GM
|
Facility
|
IP
|
$61.24
|
|
|
Service Code
|
NDC 37682210
|
| Hospital Charge Code |
25003385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$58.79 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.77
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cigna Commercial |
$50.83
|
| Rate for Payer: First Health Commercial |
$58.18
|
| Rate for Payer: Humana Commercial |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.26
|
| Rate for Payer: PHCS Commercial |
$58.79
|
| Rate for Payer: United Healthcare All Payer |
$53.89
|
|
|
PROCTOFOAM-HC (PRAMOXINE/ 10GM
|
Facility
|
OP
|
$61.24
|
|
|
Service Code
|
NDC 37682210
|
| Hospital Charge Code |
25003385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$58.79 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Anthem Medicaid |
$21.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.77
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cigna Commercial |
$50.83
|
| Rate for Payer: First Health Commercial |
$58.18
|
| Rate for Payer: Humana Commercial |
$52.05
|
| Rate for Payer: Humana KY Medicaid |
$21.06
|
| Rate for Payer: Kentucky WC Medicaid |
$21.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.26
|
| Rate for Payer: PHCS Commercial |
$58.79
|
| Rate for Payer: United Healthcare All Payer |
$53.89
|
|
|
PROCTOFOAM (PRAMOXINE) AE 15GM
|
Facility
|
IP
|
$6.75
|
|
|
Service Code
|
NDC 37682315
|
| Hospital Charge Code |
25001246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.26
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.60
|
| Rate for Payer: First Health Commercial |
$6.41
|
| Rate for Payer: Humana Commercial |
$5.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.94
|
| Rate for Payer: Ohio Health Group HMO |
$5.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Payer |
$5.94
|
|
|
PROCTOFOAM (PRAMOXINE) AE 15GM
|
Facility
|
OP
|
$6.75
|
|
|
Service Code
|
NDC 37682315
|
| Hospital Charge Code |
25001246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Anthem Medicaid |
$2.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.26
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.60
|
| Rate for Payer: First Health Commercial |
$6.41
|
| Rate for Payer: Humana Commercial |
$5.74
|
| Rate for Payer: Humana KY Medicaid |
$2.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.94
|
| Rate for Payer: Ohio Health Group HMO |
$5.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Payer |
$5.94
|
|
