|
PHENOBARBITAL 32.4 MG TABLET
|
Facility
|
OP
|
$60.15
|
|
|
Service Code
|
NDC 16571067301
|
| Hospital Charge Code |
25003352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.50
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
PHENOL
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
76102350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
PHENOL
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
76102350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$1,151.65 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
PHENOL
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
76102350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$386.94 |
| Rate for Payer: Aetna Commercial |
$283.51
|
| Rate for Payer: Ambetter Exchange |
$113.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.04
|
| Rate for Payer: Anthem Medicaid |
$99.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.84
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$386.94
|
| Rate for Payer: Healthspan PPO |
$280.49
|
| Rate for Payer: Humana Medicaid |
$99.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.93
|
| Rate for Payer: Molina Healthcare Passport |
$99.93
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.16
|
| Rate for Payer: UHCCP Medicaid |
$92.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.20
|
|
|
PHENOL EZ 89% SWAB
|
Facility
|
OP
|
$12.55
|
|
|
Service Code
|
NDC 884629730
|
| Hospital Charge Code |
25003742
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$9.66
|
| Rate for Payer: Anthem Medicaid |
$4.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.79
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cigna Commercial |
$10.42
|
| Rate for Payer: First Health Commercial |
$11.92
|
| Rate for Payer: Humana Commercial |
$10.67
|
| Rate for Payer: Humana KY Medicaid |
$4.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.04
|
| Rate for Payer: Ohio Health Group HMO |
$9.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.66
|
| Rate for Payer: PHCS Commercial |
$12.05
|
| Rate for Payer: United Healthcare All Payer |
$11.04
|
|
|
PHENOL EZ 89% SWAB
|
Facility
|
IP
|
$12.55
|
|
|
Service Code
|
NDC 884629730
|
| Hospital Charge Code |
25003742
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Aetna Commercial |
$9.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.79
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cigna Commercial |
$10.42
|
| Rate for Payer: First Health Commercial |
$11.92
|
| Rate for Payer: Humana Commercial |
$10.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.04
|
| Rate for Payer: Ohio Health Group HMO |
$9.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.66
|
| Rate for Payer: PHCS Commercial |
$12.05
|
| Rate for Payer: United Healthcare All Payer |
$11.04
|
|
|
PHENOL(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
761P2350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$386.94 |
| Rate for Payer: Aetna Commercial |
$283.51
|
| Rate for Payer: Ambetter Exchange |
$113.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.04
|
| Rate for Payer: Anthem Medicaid |
$99.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.84
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$386.94
|
| Rate for Payer: Healthspan PPO |
$280.49
|
| Rate for Payer: Humana Medicaid |
$99.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.93
|
| Rate for Payer: Molina Healthcare Passport |
$99.93
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.16
|
| Rate for Payer: UHCCP Medicaid |
$92.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.20
|
|
|
PHENYLEPHRINE 10% EYE DROP 5ML
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
25003354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| 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 |
$1.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| 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 |
$0.57 |
| 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 |
$1.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| 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
|
| Min. Negotiated Rate |
$0.01 |
| 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 |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| 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
|
| Min. Negotiated Rate |
$0.01 |
| 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 |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
PHENYLEPHRINE 20mcg(100mg SDV)
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002282
|
|
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
|
|
|
PHENYLEPHRINE 20mcg(100mg SDV)
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002282
|
|
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
|
|
|
PHENYLEPHRINE 20mcg (10mg KIT)
|
Facility
|
IP
|
$546.80
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.04 |
| Max. Negotiated Rate |
$524.93 |
| Rate for Payer: Aetna Commercial |
$421.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.50
|
| Rate for Payer: Cash Price |
$273.40
|
| Rate for Payer: Cigna Commercial |
$453.84
|
| Rate for Payer: First Health Commercial |
$519.46
|
| Rate for Payer: Humana Commercial |
$464.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.18
|
| Rate for Payer: Ohio Health Group HMO |
$410.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.29
|
| Rate for Payer: PHCS Commercial |
$524.93
|
| Rate for Payer: United Healthcare All Payer |
$481.18
|
|
|
PHENYLEPHRINE 20mcg (10mg KIT)
|
Facility
|
OP
|
$546.80
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.04 |
| Max. Negotiated Rate |
$524.93 |
| Rate for Payer: Aetna Commercial |
$421.04
|
| Rate for Payer: Anthem Medicaid |
$188.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.50
|
| Rate for Payer: Cash Price |
$273.40
|
| Rate for Payer: Cigna Commercial |
$453.84
|
| Rate for Payer: First Health Commercial |
$519.46
|
| Rate for Payer: Humana Commercial |
$464.78
|
| Rate for Payer: Humana KY Medicaid |
$188.04
|
| Rate for Payer: Kentucky WC Medicaid |
$189.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.18
|
| Rate for Payer: Ohio Health Group HMO |
$410.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.29
|
| Rate for Payer: PHCS Commercial |
$524.93
|
| Rate for Payer: United Healthcare All Payer |
$481.18
|
|
|
PHENYLEPHRINE 20mcg (10mg SDV)
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
PHENYLEPHRINE 20mcg (10mg SDV)
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
PHENYLEPHRINE20mcg(500mcg SDA)
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
25004394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.25
|
| 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 |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.80
|
| Rate for Payer: PHCS Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Payer |
$23.98
|
|
|
PHENYLEPHRINE20mcg(500mcg SDA)
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
HCPCS J2372
|
| Hospital Charge Code |
25004394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Anthem Medicaid |
$9.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.25
|
| 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: 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 |
$8.18
|
| 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 |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.80
|
| Rate for Payer: PHCS Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Payer |
$23.98
|
|
|
PHENYLEPHRINE 20mcg (50mg BAG)
|
Facility
|
IP
|
$117.25
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$112.56 |
| Rate for Payer: Aetna Commercial |
$90.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.45
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$97.32
|
| Rate for Payer: First Health Commercial |
$111.39
|
| Rate for Payer: Humana Commercial |
$99.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.18
|
| Rate for Payer: Ohio Health Group HMO |
$87.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.90
|
| Rate for Payer: PHCS Commercial |
$112.56
|
| Rate for Payer: United Healthcare All Payer |
$103.18
|
|
|
PHENYLEPHRINE 20mcg (50mg BAG)
|
Facility
|
OP
|
$117.25
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$112.56 |
| Rate for Payer: Aetna Commercial |
$90.28
|
| Rate for Payer: Anthem Medicaid |
$40.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.45
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$97.32
|
| Rate for Payer: First Health Commercial |
$111.39
|
| Rate for Payer: Humana Commercial |
$99.66
|
| Rate for Payer: Humana KY Medicaid |
$40.32
|
| Rate for Payer: Kentucky WC Medicaid |
$40.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.18
|
| Rate for Payer: Ohio Health Group HMO |
$87.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.90
|
| Rate for Payer: PHCS Commercial |
$112.56
|
| Rate for Payer: United Healthcare All Payer |
$103.18
|
|
|
PHENYLEPHRINE 20mcg (50mg SDV)
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
PHENYLEPHRINE 20mcg (50mg SDV)
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J2371
|
| Hospital Charge Code |
25002279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
PHENYTOIN SODIUM 100MG/2ML
|
Facility
|
OP
|
$77.39
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
25003902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| 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 |
$61.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.40
|
| 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 |
$23.22 |
| 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 |
$61.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.40
|
| Rate for Payer: PHCS Commercial |
$74.29
|
| Rate for Payer: United Healthcare All Payer |
$68.10
|
|
