|
PHENYLEPHRINE 10% EYE DROP 5ML
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
25003354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.49
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.59
|
| Rate for Payer: First Health Commercial |
$1.81
|
| Rate for Payer: Humana Commercial |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.68
|
| Rate for Payer: Ohio Health Group HMO |
$1.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.59
|
| Rate for Payer: PHCS Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Payer |
$1.68
|
|
|
PHENYLEPHRINE 10% EYE DROP 5ML
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
25003354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna Commercial |
$1.47
|
| Rate for Payer: Anthem Medicaid |
$0.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.49
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.59
|
| Rate for Payer: First Health Commercial |
$1.81
|
| Rate for Payer: Humana Commercial |
$1.62
|
| Rate for Payer: Humana KY Medicaid |
$0.66
|
| Rate for Payer: Kentucky WC Medicaid |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.68
|
| Rate for Payer: Ohio Health Group HMO |
$1.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.59
|
| Rate for Payer: PHCS Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Payer |
$1.68
|
|
|
PHENYLEPHRINE 1% 30mL NasalSpr
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 67208601
|
| Hospital Charge Code |
25003965
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
PHENYLEPHRINE 1% 30mL NasalSpr
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 67208601
|
| Hospital Charge Code |
25003965
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
PHENYLEPHRINE 20mcg(100mg SDV)
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| 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 |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PHENYLEPHRINE 20mcg(100mg SDV)
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| 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 |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
PHENYLEPHRINE 20mcg (10mg KIT)
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$598.08 |
| Rate for Payer: Aetna Commercial |
$479.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.94
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: Cigna Commercial |
$517.09
|
| Rate for Payer: First Health Commercial |
$591.85
|
| Rate for Payer: Humana Commercial |
$529.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$548.24
|
| Rate for Payer: Ohio Health Group HMO |
$467.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.13
|
| Rate for Payer: PHCS Commercial |
$598.08
|
| Rate for Payer: United Healthcare All Payer |
$548.24
|
|
|
PHENYLEPHRINE 20mcg (10mg KIT)
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$598.08 |
| Rate for Payer: Anthem Medicaid |
$214.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.94
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: Cigna Commercial |
$517.09
|
| Rate for Payer: First Health Commercial |
$591.85
|
| Rate for Payer: Humana Commercial |
$529.55
|
| Rate for Payer: Humana KY Medicaid |
$214.25
|
| Rate for Payer: Kentucky WC Medicaid |
$216.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$548.24
|
| Rate for Payer: Ohio Health Group HMO |
$467.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.13
|
| Rate for Payer: PHCS Commercial |
$598.08
|
| Rate for Payer: United Healthcare All Payer |
$548.24
|
| Rate for Payer: Aetna Commercial |
$479.71
|
|
|
PHENYLEPHRINE 20mcg (10mg SDV)
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
PHENYLEPHRINE 20mcg (10mg SDV)
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
PHENYLEPHRINE 20mcg (1mg SYR)
|
Facility
|
IP
|
$63.39
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$60.85 |
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.44
|
| Rate for Payer: Cash Price |
$31.70
|
| Rate for Payer: Cigna Commercial |
$52.61
|
| Rate for Payer: First Health Commercial |
$60.22
|
| Rate for Payer: Humana Commercial |
$53.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.78
|
| Rate for Payer: Ohio Health Group HMO |
$47.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.65
|
| Rate for Payer: PHCS Commercial |
$60.85
|
| Rate for Payer: United Healthcare All Payer |
$55.78
|
|
|
PHENYLEPHRINE 20mcg (1mg SYR)
|
Facility
|
OP
|
$63.39
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$60.85 |
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Anthem Medicaid |
$21.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.44
|
| Rate for Payer: Cash Price |
$31.70
|
| Rate for Payer: Cigna Commercial |
$52.61
|
| Rate for Payer: First Health Commercial |
$60.22
|
| Rate for Payer: Humana Commercial |
$53.88
|
| Rate for Payer: Humana KY Medicaid |
$21.80
|
| Rate for Payer: Kentucky WC Medicaid |
$22.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.78
|
| Rate for Payer: Ohio Health Group HMO |
$47.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.65
|
| Rate for Payer: PHCS Commercial |
$60.85
|
| Rate for Payer: United Healthcare All Payer |
$55.78
|
|
|
PHENYLEPHRINE20mcg(500mcg SDA)
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
25004394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Anthem Medicaid |
$9.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.24
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: First Health Commercial |
$25.89
|
| Rate for Payer: Humana Commercial |
$23.16
|
| Rate for Payer: Humana KY Medicaid |
$9.37
|
| Rate for Payer: Humana Medicare Advantage |
$0.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.98
|
| Rate for Payer: Ohio Health Group HMO |
$20.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.45
|
| Rate for Payer: PHCS Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Payer |
$23.98
|
|
|
PHENYLEPHRINE20mcg(500mcg SDA)
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
25004394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.26
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cigna Commercial |
$22.62
|
| Rate for Payer: First Health Commercial |
$25.89
|
| Rate for Payer: Humana Commercial |
$23.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.98
|
| Rate for Payer: Ohio Health Group HMO |
$20.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.45
|
| Rate for Payer: PHCS Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Payer |
$23.98
|
|
|
PHENYLEPHRINE 20mcg (50mg BAG)
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$117.31 |
| Rate for Payer: Aetna Commercial |
$94.09
|
| Rate for Payer: Anthem Medicaid |
$42.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.32
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cigna Commercial |
$101.43
|
| Rate for Payer: First Health Commercial |
$116.09
|
| Rate for Payer: Humana Commercial |
$103.87
|
| Rate for Payer: Humana KY Medicaid |
$42.02
|
| Rate for Payer: Kentucky WC Medicaid |
$42.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.54
|
| Rate for Payer: Ohio Health Group HMO |
$91.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.88
|
| Rate for Payer: PHCS Commercial |
$117.31
|
| Rate for Payer: United Healthcare All Payer |
$107.54
|
|
|
PHENYLEPHRINE 20mcg (50mg BAG)
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$117.31 |
| Rate for Payer: Aetna Commercial |
$94.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.32
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cigna Commercial |
$101.43
|
| Rate for Payer: First Health Commercial |
$116.09
|
| Rate for Payer: Humana Commercial |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.54
|
| Rate for Payer: Ohio Health Group HMO |
$91.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.88
|
| Rate for Payer: PHCS Commercial |
$117.31
|
| Rate for Payer: United Healthcare All Payer |
$107.54
|
|
|
PHENYLEPHRINE 20mcg (50mg SDV)
|
Facility
|
OP
|
$116.95
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem Medicaid |
$40.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Humana KY Medicaid |
$40.22
|
| Rate for Payer: Kentucky WC Medicaid |
$40.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.25
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
PHENYLEPHRINE 20mcg (50mg SDV)
|
Facility
|
IP
|
$116.95
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.25
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
PHENYTOIN SODIUM 100MG/2ML
|
Facility
|
OP
|
$77.39
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
25003902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.36
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.23
|
| Rate for Payer: First Health Commercial |
$73.52
|
| Rate for Payer: Humana Commercial |
$65.78
|
| Rate for Payer: Humana KY Medicaid |
$26.61
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.10
|
| Rate for Payer: Ohio Health Group HMO |
$58.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.99
|
| Rate for Payer: PHCS Commercial |
$74.29
|
| Rate for Payer: United Healthcare All Payer |
$68.10
|
|
|
PHENYTOIN SODIUM 100MG/2ML
|
Facility
|
IP
|
$77.39
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
25003902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.36
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.23
|
| Rate for Payer: First Health Commercial |
$73.52
|
| Rate for Payer: Humana Commercial |
$65.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.10
|
| Rate for Payer: Ohio Health Group HMO |
$58.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.99
|
| Rate for Payer: PHCS Commercial |
$74.29
|
| Rate for Payer: United Healthcare All Payer |
$68.10
|
|
|
PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
94000008
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
94000008
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$51.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$51.24
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
PH MONITOR
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna Commercial |
$790.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$800.28
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$851.58
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Humana Commercial |
$872.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$841.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$757.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.88
|
| Rate for Payer: Ohio Health Group HMO |
$769.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.06
|
| Rate for Payer: PHCS Commercial |
$984.96
|
| Rate for Payer: United Healthcare All Payer |
$902.88
|
|
|
PH MONITOR
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna Commercial |
$790.02
|
| Rate for Payer: Anthem Medicaid |
$352.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$800.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$851.58
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Humana Commercial |
$872.10
|
| Rate for Payer: Humana KY Medicaid |
$352.84
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$356.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$841.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$757.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.88
|
| Rate for Payer: Ohio Health Group HMO |
$769.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.06
|
| Rate for Payer: PHCS Commercial |
$984.96
|
| Rate for Payer: United Healthcare All Payer |
$902.88
|
|
|
PH MONITOR
|
Professional
|
Both
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Aetna Commercial |
$684.78
|
| Rate for Payer: Anthem Medicaid |
$325.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$602.95
|
| Rate for Payer: Healthspan PPO |
$560.38
|
| Rate for Payer: Humana Medicaid |
$325.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.38
|
| Rate for Payer: Molina Healthcare Passport |
$325.86
|
| Rate for Payer: Multiplan PHCS |
$615.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$718.20
|
| Rate for Payer: UHCCP Medicaid |
$359.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.12
|
|
