|
PROMODEL ORTHOBIOLOGIC INJ 5CC
|
Facility
|
IP
|
$7,263.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.96 |
| Max. Negotiated Rate |
$6,972.67 |
| Rate for Payer: Aetna Commercial |
$5,592.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,665.30
|
| Rate for Payer: Cash Price |
$3,631.60
|
| Rate for Payer: Cigna Commercial |
$6,028.46
|
| Rate for Payer: First Health Commercial |
$6,900.04
|
| Rate for Payer: Humana Commercial |
$6,173.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,955.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,360.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,391.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,447.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,810.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,318.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,011.61
|
| Rate for Payer: PHCS Commercial |
$6,972.67
|
| Rate for Payer: United Healthcare All Payer |
$6,391.62
|
|
|
PROMOS HUM STEM CEMENTLESS
|
Facility
|
OP
|
$9,697.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,909.32 |
| Max. Negotiated Rate |
$9,309.84 |
| Rate for Payer: Aetna Commercial |
$7,467.27
|
| Rate for Payer: Anthem Medicaid |
$3,335.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.24
|
| Rate for Payer: Cash Price |
$4,848.88
|
| Rate for Payer: Cigna Commercial |
$8,049.13
|
| Rate for Payer: First Health Commercial |
$9,212.86
|
| Rate for Payer: Humana Commercial |
$8,243.09
|
| Rate for Payer: Humana KY Medicaid |
$3,335.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,156.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,401.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,437.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,691.45
|
| Rate for Payer: PHCS Commercial |
$9,309.84
|
| Rate for Payer: United Healthcare All Payer |
$8,534.02
|
|
|
PROMOS HUM STEM CEMENTLESS
|
Facility
|
IP
|
$9,697.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,909.32 |
| Max. Negotiated Rate |
$9,309.84 |
| Rate for Payer: Aetna Commercial |
$7,467.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.24
|
| Rate for Payer: Cash Price |
$4,848.88
|
| Rate for Payer: Cigna Commercial |
$8,049.13
|
| Rate for Payer: First Health Commercial |
$9,212.86
|
| Rate for Payer: Humana Commercial |
$8,243.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,156.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,437.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,691.45
|
| Rate for Payer: PHCS Commercial |
$9,309.84
|
| Rate for Payer: United Healthcare All Payer |
$8,534.02
|
|
|
PRONESTYL 1000MG/10ML VIAL
|
Facility
|
OP
|
$989.83
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
25002325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.32 |
| Max. Negotiated Rate |
$950.24 |
| Rate for Payer: Aetna Commercial |
$762.17
|
| Rate for Payer: Anthem Medicaid |
$340.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.33
|
| Rate for Payer: Cash Price |
$494.92
|
| Rate for Payer: Cash Price |
$494.92
|
| Rate for Payer: Cigna Commercial |
$821.56
|
| Rate for Payer: First Health Commercial |
$940.34
|
| Rate for Payer: Humana Commercial |
$841.36
|
| Rate for Payer: Humana KY Medicaid |
$340.40
|
| Rate for Payer: Humana Medicare Advantage |
$194.32
|
| Rate for Payer: Kentucky WC Medicaid |
$343.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$811.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$730.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$871.05
|
| Rate for Payer: Ohio Health Group HMO |
$742.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.98
|
| Rate for Payer: PHCS Commercial |
$950.24
|
| Rate for Payer: United Healthcare All Payer |
$871.05
|
|
|
PRONESTYL 1000MG/10ML VIAL
|
Facility
|
IP
|
$989.83
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
25002325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.95 |
| Max. Negotiated Rate |
$950.24 |
| Rate for Payer: Aetna Commercial |
$762.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.07
|
| Rate for Payer: Cash Price |
$494.92
|
| Rate for Payer: Cigna Commercial |
$821.56
|
| Rate for Payer: First Health Commercial |
$940.34
|
| Rate for Payer: Humana Commercial |
$841.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$811.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$730.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$871.05
|
| Rate for Payer: Ohio Health Group HMO |
$742.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.98
|
| Rate for Payer: PHCS Commercial |
$950.24
|
| Rate for Payer: United Healthcare All Payer |
$871.05
|
|
|
PRONOX
|
Professional
|
Both
|
$40.00
|
|
| Hospital Charge Code |
22200206
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
|
|
PROPEL MOMETASONE FUROATE IMP
|
Facility
|
OP
|
$6,719.35
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.81 |
| Max. Negotiated Rate |
$6,450.58 |
| Rate for Payer: Aetna Commercial |
$5,173.90
|
| Rate for Payer: Anthem Medicaid |
$2,310.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,241.09
|
| Rate for Payer: Cash Price |
$3,359.68
|
| Rate for Payer: Cigna Commercial |
$5,577.06
|
| Rate for Payer: First Health Commercial |
$6,383.38
|
| Rate for Payer: Humana Commercial |
$5,711.45
|
| Rate for Payer: Humana KY Medicaid |
$2,310.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,334.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,357.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,913.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,039.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,845.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,636.35
|
| Rate for Payer: PHCS Commercial |
$6,450.58
|
| Rate for Payer: United Healthcare All Payer |
$5,913.03
|
|
|
PROPEL MOMETASONE FUROATE IMP
|
Facility
|
IP
|
$6,719.35
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.81 |
| Max. Negotiated Rate |
$6,450.58 |
| Rate for Payer: Aetna Commercial |
$5,173.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,241.09
|
| Rate for Payer: Cash Price |
$3,359.68
|
| Rate for Payer: Cigna Commercial |
$5,577.06
|
| Rate for Payer: First Health Commercial |
$6,383.38
|
| Rate for Payer: Humana Commercial |
$5,711.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,913.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,039.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,845.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,636.35
|
| Rate for Payer: PHCS Commercial |
$6,450.58
|
| Rate for Payer: United Healthcare All Payer |
$5,913.03
|
|
|
PROPYLTHIOURACIL 50 50MG/1TAB
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 480924201
|
| Hospital Charge Code |
25001257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROPYLTHIOURACIL 50 50MG/1TAB
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 480924201
|
| Hospital Charge Code |
25001257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROSCAR (FINASTERIDE) 5MG/1TAB
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 31722052590
|
| Hospital Charge Code |
25001258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| 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 |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
PROSCAR (FINASTERIDE) 5MG/1TAB
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 31722052590
|
| Hospital Charge Code |
25001258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| 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 |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
PROSTALAC ACETABULAR CUP 42*32
|
Facility
|
OP
|
$8,230.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.14 |
| Max. Negotiated Rate |
$7,901.23 |
| Rate for Payer: Aetna Commercial |
$6,337.45
|
| Rate for Payer: Anthem Medicaid |
$2,830.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,419.75
|
| Rate for Payer: Cash Price |
$4,115.23
|
| Rate for Payer: Cigna Commercial |
$6,831.27
|
| Rate for Payer: First Health Commercial |
$7,818.93
|
| Rate for Payer: Humana Commercial |
$6,995.88
|
| Rate for Payer: Humana KY Medicaid |
$2,830.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,859.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,074.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,887.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,242.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,679.01
|
| Rate for Payer: PHCS Commercial |
$7,901.23
|
| Rate for Payer: United Healthcare All Payer |
$7,242.80
|
|
|
PROSTALAC ACETABULAR CUP 42*32
|
Facility
|
IP
|
$8,230.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.14 |
| Max. Negotiated Rate |
$7,901.23 |
| Rate for Payer: Aetna Commercial |
$6,337.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,419.75
|
| Rate for Payer: Cash Price |
$4,115.23
|
| Rate for Payer: Cigna Commercial |
$6,831.27
|
| Rate for Payer: First Health Commercial |
$7,818.93
|
| Rate for Payer: Humana Commercial |
$6,995.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,074.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,242.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,160.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,679.01
|
| Rate for Payer: PHCS Commercial |
$7,901.23
|
| Rate for Payer: United Healthcare All Payer |
$7,242.80
|
|
|
PROSTALAC HIP STEM SZ3 200MM L
|
Facility
|
IP
|
$27,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,169.00 |
| Max. Negotiated Rate |
$26,140.80 |
| Rate for Payer: Aetna Commercial |
$20,967.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,239.40
|
| Rate for Payer: Cash Price |
$13,615.00
|
| Rate for Payer: Cigna Commercial |
$22,600.90
|
| Rate for Payer: First Health Commercial |
$25,868.50
|
| Rate for Payer: Humana Commercial |
$23,145.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,328.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,095.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,169.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,962.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,690.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,788.70
|
| Rate for Payer: PHCS Commercial |
$26,140.80
|
| Rate for Payer: United Healthcare All Payer |
$23,962.40
|
|
|
PROSTALAC HIP STEM SZ3 200MM L
|
Facility
|
OP
|
$27,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,169.00 |
| Max. Negotiated Rate |
$26,140.80 |
| Rate for Payer: Aetna Commercial |
$20,967.10
|
| Rate for Payer: Anthem Medicaid |
$9,364.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,239.40
|
| Rate for Payer: Cash Price |
$13,615.00
|
| Rate for Payer: Cigna Commercial |
$22,600.90
|
| Rate for Payer: First Health Commercial |
$25,868.50
|
| Rate for Payer: Humana Commercial |
$23,145.50
|
| Rate for Payer: Humana KY Medicaid |
$9,364.40
|
| Rate for Payer: Kentucky WC Medicaid |
$9,459.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,328.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,095.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,169.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,552.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,962.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,690.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,788.70
|
| Rate for Payer: PHCS Commercial |
$26,140.80
|
| Rate for Payer: United Healthcare All Payer |
$23,962.40
|
|
|
PROSTALAC HIP STEM SZ3 200MM R
|
Facility
|
OP
|
$32,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,899.25 |
| Max. Negotiated Rate |
$31,677.60 |
| Rate for Payer: Aetna Commercial |
$25,408.08
|
| Rate for Payer: Anthem Medicaid |
$11,347.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,738.05
|
| Rate for Payer: Cash Price |
$16,498.75
|
| Rate for Payer: Cigna Commercial |
$27,387.92
|
| Rate for Payer: First Health Commercial |
$31,347.62
|
| Rate for Payer: Humana Commercial |
$28,047.88
|
| Rate for Payer: Humana KY Medicaid |
$11,347.84
|
| Rate for Payer: Kentucky WC Medicaid |
$11,463.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,057.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,352.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,899.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,575.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,037.80
|
| Rate for Payer: Ohio Health Group HMO |
$24,748.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,398.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,707.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,768.28
|
| Rate for Payer: PHCS Commercial |
$31,677.60
|
| Rate for Payer: United Healthcare All Payer |
$29,037.80
|
|
|
PROSTALAC HIP STEM SZ3 200MM R
|
Facility
|
IP
|
$32,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,899.25 |
| Max. Negotiated Rate |
$31,677.60 |
| Rate for Payer: Aetna Commercial |
$25,408.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,738.05
|
| Rate for Payer: Cash Price |
$16,498.75
|
| Rate for Payer: Cigna Commercial |
$27,387.92
|
| Rate for Payer: First Health Commercial |
$31,347.62
|
| Rate for Payer: Humana Commercial |
$28,047.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,057.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,352.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,899.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,037.80
|
| Rate for Payer: Ohio Health Group HMO |
$24,748.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,398.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,707.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,768.28
|
| Rate for Payer: PHCS Commercial |
$31,677.60
|
| Rate for Payer: United Healthcare All Payer |
$29,037.80
|
|
|
PROSTAR XL 10FR
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
PROSTAR XL 10FR
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
PROSTATE BIOPSY 1-20 SPECIMENS
|
Facility
|
IP
|
$3,227.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001552
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$968.10 |
| Max. Negotiated Rate |
$3,097.92 |
| Rate for Payer: Aetna Commercial |
$2,484.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.28
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cigna Commercial |
$2,678.41
|
| Rate for Payer: First Health Commercial |
$3,065.65
|
| Rate for Payer: Humana Commercial |
$2,742.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,646.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,381.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,839.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,420.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,581.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,807.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.63
|
| Rate for Payer: PHCS Commercial |
$3,097.92
|
| Rate for Payer: United Healthcare All Payer |
$2,839.76
|
|
|
PROSTATE BIOPSY 1-20 SPECIMENS
|
Facility
|
OP
|
$3,227.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001552
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$332.37 |
| Max. Negotiated Rate |
$3,097.92 |
| Rate for Payer: Aetna Commercial |
$2,484.79
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cigna Commercial |
$2,678.41
|
| Rate for Payer: First Health Commercial |
$3,065.65
|
| Rate for Payer: Humana Commercial |
$2,742.95
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,646.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,381.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,839.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,420.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,581.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,807.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.63
|
| Rate for Payer: PHCS Commercial |
$3,097.92
|
| Rate for Payer: United Healthcare All Payer |
$2,839.76
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$963.98 |
| Rate for Payer: Aetna Commercial |
$963.98
|
| Rate for Payer: Ambetter Exchange |
$333.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$400.42
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.68
|
| Rate for Payer: Multiplan PHCS |
$544.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.78
|
| Rate for Payer: UHCCP Medicaid |
$317.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.68
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.10 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.32
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$789.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.83
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
PROSTATE BIOPSY, ANY MTHD
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
30001876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$332.37 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$789.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.83
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
