|
PROSTATECTOMY (TURP)
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
PROSTATECTOMY (TURP)
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.31 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,343.79
|
| Rate for Payer: Ambetter Exchange |
$688.32
|
| Rate for Payer: Anthem Medicaid |
$684.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$688.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$688.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.98
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,183.14
|
| Rate for Payer: Healthspan PPO |
$1,074.48
|
| Rate for Payer: Humana Medicaid |
$684.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,140.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$688.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.00
|
| Rate for Payer: Molina Healthcare Passport |
$684.31
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$894.82
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$688.32
|
|
|
PROSTATECTOMY (TURP)
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
76102113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
PROSTATECTOMY (TURP)(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
761P2113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.31 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,343.79
|
| Rate for Payer: Ambetter Exchange |
$688.32
|
| Rate for Payer: Anthem Medicaid |
$684.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$688.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$688.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.98
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,183.14
|
| Rate for Payer: Healthspan PPO |
$1,074.48
|
| Rate for Payer: Humana Medicaid |
$684.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,140.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$688.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.00
|
| Rate for Payer: Molina Healthcare Passport |
$684.31
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$894.82
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$688.32
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
43000032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTHETIC FIT TRAINING 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
43000032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
PROSTIGMINE 0.5 MG (10MG/10ML)
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
PROSTIGMINE 0.5 MG (10MG/10ML)
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
PROSTIGMINE 0.5 MG [2 MG SYR]
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.90 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Aetna Commercial |
$61.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.14
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.13
|
| Rate for Payer: First Health Commercial |
$75.69
|
| Rate for Payer: Humana Commercial |
$67.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.11
|
| Rate for Payer: Ohio Health Group HMO |
$59.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.97
|
| Rate for Payer: PHCS Commercial |
$76.48
|
| Rate for Payer: United Healthcare All Payer |
$70.11
|
|
|
PROSTIGMINE 0.5 MG [2 MG SYR]
|
Facility
|
OP
|
$79.67
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.90 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Aetna Commercial |
$61.35
|
| Rate for Payer: Anthem Medicaid |
$27.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.14
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.13
|
| Rate for Payer: First Health Commercial |
$75.69
|
| Rate for Payer: Humana Commercial |
$67.72
|
| Rate for Payer: Humana KY Medicaid |
$27.40
|
| Rate for Payer: Kentucky WC Medicaid |
$27.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.11
|
| Rate for Payer: Ohio Health Group HMO |
$59.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.97
|
| Rate for Payer: PHCS Commercial |
$76.48
|
| Rate for Payer: United Healthcare All Payer |
$70.11
|
|
|
PROSTIGMINE(NEOSTIG)0.5 MG
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PROSTIGMINE(NEOSTIG)0.5 MG
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
25002331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$62.25
|
| Rate for Payer: Kentucky WC Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PROSTIN VR PED (ALP 500MCG/1ML
|
Facility
|
OP
|
$922.90
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25001851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.87 |
| Max. Negotiated Rate |
$885.98 |
| Rate for Payer: Aetna Commercial |
$710.63
|
| Rate for Payer: Anthem Medicaid |
$317.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.86
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Cigna Commercial |
$766.01
|
| Rate for Payer: First Health Commercial |
$876.75
|
| Rate for Payer: Humana Commercial |
$784.47
|
| Rate for Payer: Humana KY Medicaid |
$317.39
|
| Rate for Payer: Kentucky WC Medicaid |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$323.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$812.15
|
| Rate for Payer: Ohio Health Group HMO |
$692.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$802.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.80
|
| Rate for Payer: PHCS Commercial |
$885.98
|
| Rate for Payer: United Healthcare All Payer |
$812.15
|
|
|
PROSTIN VR PED (ALP 500MCG/1ML
|
Facility
|
IP
|
$922.90
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25001851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.87 |
| Max. Negotiated Rate |
$885.98 |
| Rate for Payer: Aetna Commercial |
$710.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.86
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Cigna Commercial |
$766.01
|
| Rate for Payer: First Health Commercial |
$876.75
|
| Rate for Payer: Humana Commercial |
$784.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$812.15
|
| Rate for Payer: Ohio Health Group HMO |
$692.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$802.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.80
|
| Rate for Payer: PHCS Commercial |
$885.98
|
| Rate for Payer: United Healthcare All Payer |
$812.15
|
|
|
PROTAMINESULFA10MG(250 MG/10ML
|
Facility
|
IP
|
$321.91
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25002332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$309.03 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.09
|
| Rate for Payer: Cash Price |
$160.96
|
| Rate for Payer: Cigna Commercial |
$267.19
|
| Rate for Payer: First Health Commercial |
$305.81
|
| Rate for Payer: Humana Commercial |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.28
|
| Rate for Payer: Ohio Health Group HMO |
$241.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.12
|
| Rate for Payer: PHCS Commercial |
$309.03
|
| Rate for Payer: United Healthcare All Payer |
$283.28
|
|
|
PROTAMINESULFA10MG(250 MG/10ML
|
Facility
|
OP
|
$321.91
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25002332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$309.03 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Anthem Medicaid |
$110.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.09
|
| Rate for Payer: Cash Price |
$160.96
|
| Rate for Payer: Cigna Commercial |
$267.19
|
| Rate for Payer: First Health Commercial |
$305.81
|
| Rate for Payer: Humana Commercial |
$273.62
|
| Rate for Payer: Humana KY Medicaid |
$110.70
|
| Rate for Payer: Kentucky WC Medicaid |
$111.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.28
|
| Rate for Payer: Ohio Health Group HMO |
$241.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.12
|
| Rate for Payer: PHCS Commercial |
$309.03
|
| Rate for Payer: United Healthcare All Payer |
$283.28
|
|
|
PROTAMINE SULFATE 50 50MG/5ML
|
Facility
|
OP
|
$122.48
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25003389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Anthem Medicaid |
$42.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.53
|
| Rate for Payer: Cash Price |
$61.24
|
| Rate for Payer: Cigna Commercial |
$101.66
|
| Rate for Payer: First Health Commercial |
$116.36
|
| Rate for Payer: Humana Commercial |
$104.11
|
| Rate for Payer: Humana KY Medicaid |
$42.12
|
| Rate for Payer: Kentucky WC Medicaid |
$42.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.51
|
| Rate for Payer: PHCS Commercial |
$117.58
|
| Rate for Payer: United Healthcare All Payer |
$107.78
|
|
|
PROTAMINE SULFATE 50 50MG/5ML
|
Facility
|
IP
|
$122.48
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25003389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.53
|
| Rate for Payer: Cash Price |
$61.24
|
| Rate for Payer: Cigna Commercial |
$101.66
|
| Rate for Payer: First Health Commercial |
$116.36
|
| Rate for Payer: Humana Commercial |
$104.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.51
|
| Rate for Payer: PHCS Commercial |
$117.58
|
| Rate for Payer: United Healthcare All Payer |
$107.78
|
|
|
PROTECT AND SERVE TINT 30SPF
|
Professional
|
Both
|
$65.00
|
|
| Hospital Charge Code |
22200131
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
PROTECT AND SERVE TINT 30SPF
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
22200131
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
PROTECT AND SERVE TINT 30SPF
|
Facility
|
IP
|
$65.00
|
|
| Hospital Charge Code |
22200131
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
PROTECTIVE SHEATH
|
Facility
|
OP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem Medicaid |
$189.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Humana KY Medicaid |
$189.48
|
| Rate for Payer: Kentucky WC Medicaid |
$191.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
|
PROTECTIVE SHEATH
|
Facility
|
IP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
