|
Pro-fractionl cheek-PP#2/3 25%
|
Professional
|
Both
|
$892.00
|
|
| Hospital Charge Code |
22200677
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$624.40 |
| Rate for Payer: Cash Price |
$446.00
|
| Rate for Payer: Multiplan PHCS |
$535.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$624.40
|
| Rate for Payer: UHCCP Medicaid |
$312.20
|
|
|
PROGEL PLEURAL SEALANT KIT
|
Facility
|
OP
|
$7,423.80
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
25001808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,227.14 |
| Max. Negotiated Rate |
$7,126.85 |
| Rate for Payer: Aetna Commercial |
$5,716.33
|
| Rate for Payer: Anthem Medicaid |
$2,553.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,790.56
|
| Rate for Payer: Cash Price |
$3,711.90
|
| Rate for Payer: Cigna Commercial |
$6,161.75
|
| Rate for Payer: First Health Commercial |
$7,052.61
|
| Rate for Payer: Humana Commercial |
$6,310.23
|
| Rate for Payer: Humana KY Medicaid |
$2,553.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,579.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,087.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,478.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,227.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,604.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,532.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,939.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,458.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,122.42
|
| Rate for Payer: PHCS Commercial |
$7,126.85
|
| Rate for Payer: United Healthcare All Payer |
$6,532.94
|
|
|
PROGEL PLEURAL SEALANT KIT
|
Facility
|
IP
|
$7,423.80
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
25001808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,227.14 |
| Max. Negotiated Rate |
$7,126.85 |
| Rate for Payer: Aetna Commercial |
$5,716.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,790.56
|
| Rate for Payer: Cash Price |
$3,711.90
|
| Rate for Payer: Cigna Commercial |
$6,161.75
|
| Rate for Payer: First Health Commercial |
$7,052.61
|
| Rate for Payer: Humana Commercial |
$6,310.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,087.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,478.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,227.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,532.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,939.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,458.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,122.42
|
| Rate for Payer: PHCS Commercial |
$7,126.85
|
| Rate for Payer: United Healthcare All Payer |
$6,532.94
|
|
|
PROGESTERONE
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$20.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.86
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$20.86
|
| Rate for Payer: Humana Medicare Advantage |
$20.86
|
| Rate for Payer: Kentucky WC Medicaid |
$21.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
PROGESTERONE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
PROGESTERONE
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
30000484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$36.40
|
| Rate for Payer: Ambetter Exchange |
$20.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.03
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: Healthspan PPO |
$20.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Multiplan PHCS |
$111.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.12
|
| Rate for Payer: UHCCP Medicaid |
$65.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.86
|
|
|
PROGESTERONE/OIL 50MG/ML 10MLV
|
Facility
|
OP
|
$185.90
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
25002323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$178.46 |
| Rate for Payer: Aetna Commercial |
$143.14
|
| Rate for Payer: Anthem Medicaid |
$63.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.00
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cigna Commercial |
$154.30
|
| Rate for Payer: First Health Commercial |
$176.60
|
| Rate for Payer: Humana Commercial |
$158.01
|
| Rate for Payer: Humana KY Medicaid |
$63.93
|
| Rate for Payer: Kentucky WC Medicaid |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.59
|
| Rate for Payer: Ohio Health Group HMO |
$139.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.27
|
| Rate for Payer: PHCS Commercial |
$178.46
|
| Rate for Payer: United Healthcare All Payer |
$163.59
|
|
|
PROGESTERONE/OIL 50MG/ML 10MLV
|
Facility
|
IP
|
$185.90
|
|
|
Service Code
|
HCPCS J2675
|
| Hospital Charge Code |
25002323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$178.46 |
| Rate for Payer: Aetna Commercial |
$143.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.00
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cigna Commercial |
$154.30
|
| Rate for Payer: First Health Commercial |
$176.60
|
| Rate for Payer: Humana Commercial |
$158.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.59
|
| Rate for Payer: Ohio Health Group HMO |
$139.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.27
|
| Rate for Payer: PHCS Commercial |
$178.46
|
| Rate for Payer: United Healthcare All Payer |
$163.59
|
|
|
PROGRAF 0.5MG CAPSULE
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
HCPCS J7521
|
| Hospital Charge Code |
25002494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
PROGRAF 0.5MG CAPSULE
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
HCPCS J7521
|
| Hospital Charge Code |
25002494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
PROGRAF 1MG CAPSULE
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
PROGRAF 1MG CAPSULE
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
25002495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$108.52 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Ambetter Exchange |
$70.70
|
| Rate for Payer: Anthem Medicaid |
$54.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.84
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$108.52
|
| Rate for Payer: Healthspan PPO |
$100.74
|
| Rate for Payer: Humana Medicaid |
$54.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.39
|
| Rate for Payer: Molina Healthcare Passport |
$54.30
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.91
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.70
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$49.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Humana KY Medicaid |
$49.87
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$50.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
PROGRAM DEVICE DUAL PACEMAKER
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 93280
|
| Hospital Charge Code |
48000077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.10
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
PROGREAT 2.8FR 130CM
|
Facility
|
IP
|
$4,613.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,384.12 |
| Max. Negotiated Rate |
$4,429.20 |
| Rate for Payer: Aetna Commercial |
$3,552.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.72
|
| Rate for Payer: Cash Price |
$2,306.88
|
| Rate for Payer: Cigna Commercial |
$3,829.41
|
| Rate for Payer: First Health Commercial |
$4,383.06
|
| Rate for Payer: Humana Commercial |
$3,921.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,691.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,013.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,183.49
|
| Rate for Payer: PHCS Commercial |
$4,429.20
|
| Rate for Payer: United Healthcare All Payer |
$4,060.10
|
|
|
PROGREAT 2.8FR 130CM
|
Facility
|
OP
|
$4,613.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,384.12 |
| Max. Negotiated Rate |
$4,429.20 |
| Rate for Payer: Aetna Commercial |
$3,552.59
|
| Rate for Payer: Anthem Medicaid |
$1,586.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.72
|
| Rate for Payer: Cash Price |
$2,306.88
|
| Rate for Payer: Cigna Commercial |
$3,829.41
|
| Rate for Payer: First Health Commercial |
$4,383.06
|
| Rate for Payer: Humana Commercial |
$3,921.69
|
| Rate for Payer: Humana KY Medicaid |
$1,586.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,602.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,618.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,691.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,013.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,183.49
|
| Rate for Payer: PHCS Commercial |
$4,429.20
|
| Rate for Payer: United Healthcare All Payer |
$4,060.10
|
|
|
PROGREAT MICROCATHTR 20F 150CM
|
Facility
|
IP
|
$5,418.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,625.44 |
| Max. Negotiated Rate |
$5,201.40 |
| Rate for Payer: Aetna Commercial |
$4,171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.13
|
| Rate for Payer: Cash Price |
$2,709.06
|
| Rate for Payer: Cigna Commercial |
$4,497.04
|
| Rate for Payer: First Health Commercial |
$5,147.21
|
| Rate for Payer: Humana Commercial |
$4,605.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,442.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,998.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,767.95
|
| Rate for Payer: Ohio Health Group HMO |
$4,063.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,334.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,713.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.50
|
| Rate for Payer: PHCS Commercial |
$5,201.40
|
| Rate for Payer: United Healthcare All Payer |
$4,767.95
|
|
|
PROGREAT MICROCATHTR 20F 150CM
|
Facility
|
OP
|
$5,418.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,625.44 |
| Max. Negotiated Rate |
$5,201.40 |
| Rate for Payer: Aetna Commercial |
$4,171.95
|
| Rate for Payer: Anthem Medicaid |
$1,863.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.13
|
| Rate for Payer: Cash Price |
$2,709.06
|
| Rate for Payer: Cigna Commercial |
$4,497.04
|
| Rate for Payer: First Health Commercial |
$5,147.21
|
| Rate for Payer: Humana Commercial |
$4,605.40
|
| Rate for Payer: Humana KY Medicaid |
$1,863.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,882.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,442.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,998.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,900.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,767.95
|
| Rate for Payer: Ohio Health Group HMO |
$4,063.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,334.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,713.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.50
|
| Rate for Payer: PHCS Commercial |
$5,201.40
|
| Rate for Payer: United Healthcare All Payer |
$4,767.95
|
|
|
PROLACTIN SERUM
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$45.30
|
| Rate for Payer: Ambetter Exchange |
$19.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$19.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$19.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.26
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$17.02
|
| Rate for Payer: Healthspan PPO |
$20.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$19.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.38
|
| Rate for Payer: Multiplan PHCS |
$151.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$25.19
|
| Rate for Payer: UHCCP Medicaid |
$88.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.38
|
|
|
PROLACTIN SERUM
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
PROLACTIN SERUM
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
30000486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$194.81
|
| Rate for Payer: Anthem Medicaid |
$19.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna Commercial |
$209.99
|
| Rate for Payer: First Health Commercial |
$240.35
|
| Rate for Payer: Humana Commercial |
$215.05
|
| Rate for Payer: Humana KY Medicaid |
$19.38
|
| Rate for Payer: Humana Medicare Advantage |
$19.38
|
| Rate for Payer: Kentucky WC Medicaid |
$19.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$207.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$222.64
|
| Rate for Payer: Ohio Health Group HMO |
$189.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.57
|
| Rate for Payer: PHCS Commercial |
$242.88
|
| Rate for Payer: United Healthcare All Payer |
$222.64
|
|
|
PROLASTIN-C 10MG (1000MG VL)
|
Facility
|
OP
|
$3,215.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25003386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$3,086.88 |
| Rate for Payer: Aetna Commercial |
$2,475.93
|
| Rate for Payer: Anthem Medicaid |
$1,105.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cigna Commercial |
$2,668.86
|
| Rate for Payer: First Health Commercial |
$3,054.72
|
| Rate for Payer: Humana Commercial |
$2,733.18
|
| Rate for Payer: Humana KY Medicaid |
$1,105.81
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.70
|
| Rate for Payer: PHCS Commercial |
$3,086.88
|
| Rate for Payer: United Healthcare All Payer |
$2,829.64
|
|
|
PROLASTIN-C 10MG (1000MG VL)
|
Facility
|
IP
|
$3,215.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25003386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.65 |
| Max. Negotiated Rate |
$3,086.88 |
| Rate for Payer: Aetna Commercial |
$2,475.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.09
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cigna Commercial |
$2,668.86
|
| Rate for Payer: First Health Commercial |
$3,054.72
|
| Rate for Payer: Humana Commercial |
$2,733.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.70
|
| Rate for Payer: PHCS Commercial |
$3,086.88
|
| Rate for Payer: United Healthcare All Payer |
$2,829.64
|
|
|
PROLIA 60MG/ML SYRINGE
|
Facility
|
OP
|
$10,221.09
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
25002005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$9,812.25 |
| Rate for Payer: Aetna Commercial |
$7,870.24
|
| Rate for Payer: Anthem Medicaid |
$3,515.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,972.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.47
|
| Rate for Payer: Cash Price |
$5,110.54
|
| Rate for Payer: Cash Price |
$5,110.54
|
| Rate for Payer: Cigna Commercial |
$8,483.50
|
| Rate for Payer: First Health Commercial |
$9,710.04
|
| Rate for Payer: Humana Commercial |
$8,687.93
|
| Rate for Payer: Humana KY Medicaid |
$3,515.03
|
| Rate for Payer: Humana Medicare Advantage |
$29.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,550.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,381.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,543.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,585.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,994.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,665.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,176.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,892.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,052.55
|
| Rate for Payer: PHCS Commercial |
$9,812.25
|
| Rate for Payer: United Healthcare All Payer |
$8,994.56
|
|
