|
PPPS-SUBSEQ VISIT (P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS G0349
|
| Hospital Charge Code |
510P0144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
PPPS-SUBSEQ VISIT (P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
500P0189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.04
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.00
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.42
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem Medicaid |
$150.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.42
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Humana KY Medicaid |
$150.97
|
| Rate for Payer: Kentucky WC Medicaid |
$152.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$439.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$439.00
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Healthspan PPO |
$40.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.97
|
| Rate for Payer: Multiplan PHCS |
$263.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.30
|
| Rate for Payer: UHCCP Medicaid |
$153.65
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM(T
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
770T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem Medicaid |
$150.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.42
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Humana KY Medicaid |
$150.97
|
| Rate for Payer: Kentucky WC Medicaid |
$152.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM(T
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
770T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.42
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
PRADAXA 150MG CAPSULE
|
Facility
|
OP
|
$11.31
|
|
|
Service Code
|
NDC 597036082
|
| Hospital Charge Code |
25001206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Anthem Medicaid |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.39
|
| Rate for Payer: First Health Commercial |
$10.74
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Humana KY Medicaid |
$3.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.95
|
| Rate for Payer: Ohio Health Group HMO |
$8.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.86
|
| Rate for Payer: United Healthcare All Payer |
$9.95
|
|
|
PRADAXA 150MG CAPSULE
|
Facility
|
IP
|
$11.31
|
|
|
Service Code
|
NDC 597036082
|
| Hospital Charge Code |
25001206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.39
|
| Rate for Payer: First Health Commercial |
$10.74
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.95
|
| Rate for Payer: Ohio Health Group HMO |
$8.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.86
|
| Rate for Payer: United Healthcare All Payer |
$9.95
|
|
|
PRANDIN(REPAGLINIDE)0.5 MG TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 574024001
|
| Hospital Charge Code |
25001208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
| Rate for Payer: Aetna Commercial |
$3.39
|
|
|
PRANDIN(REPAGLINIDE)0.5 MG TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 574024001
|
| Hospital Charge Code |
25001208
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
PRANDIN (REPAGLINIDE) 2 MG TAB
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 65862067201
|
| Hospital Charge Code |
25001207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
PRANDIN (REPAGLINIDE) 2 MG TAB
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 65862067201
|
| Hospital Charge Code |
25001207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
PRAVACHOL(PRAVASTATI 20MG/1TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 93720198
|
| Hospital Charge Code |
25001210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
PRAVACHOL(PRAVASTATI 20MG/1TAB
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 93720198
|
| Hospital Charge Code |
25001210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
PRAVACHOL (PRAVASTATIN) 40MG T
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 93720298
|
| Hospital Charge Code |
25001209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
PRAVACHOL (PRAVASTATIN) 40MG T
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 93720298
|
| Hospital Charge Code |
25001209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
PRAXBIND 2.5GM/50ML VIAL
|
Facility
|
OP
|
$4,203.08
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$546.40 |
| Max. Negotiated Rate |
$4,034.96 |
| Rate for Payer: Aetna Commercial |
$3,236.37
|
| Rate for Payer: Anthem Medicaid |
$1,445.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,278.40
|
| Rate for Payer: Cash Price |
$2,101.54
|
| Rate for Payer: Cigna Commercial |
$3,488.56
|
| Rate for Payer: First Health Commercial |
$3,992.93
|
| Rate for Payer: Humana Commercial |
$3,572.62
|
| Rate for Payer: Humana KY Medicaid |
$1,445.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,446.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,474.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,698.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,152.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.95
|
| Rate for Payer: PHCS Commercial |
$4,034.96
|
| Rate for Payer: United Healthcare All Payer |
$3,698.71
|
|
|
PRAXBIND 2.5GM/50ML VIAL
|
Facility
|
IP
|
$4,203.08
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$546.40 |
| Max. Negotiated Rate |
$4,034.96 |
| Rate for Payer: Aetna Commercial |
$3,236.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,278.40
|
| Rate for Payer: Cash Price |
$2,101.54
|
| Rate for Payer: Cigna Commercial |
$3,488.56
|
| Rate for Payer: First Health Commercial |
$3,992.93
|
| Rate for Payer: Humana Commercial |
$3,572.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,446.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,698.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,152.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.95
|
| Rate for Payer: PHCS Commercial |
$4,034.96
|
| Rate for Payer: United Healthcare All Payer |
$3,698.71
|
|
|
PRCRD DRG 6YR+ W/O CGEN CAR
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 33017
|
| Hospital Charge Code |
360P1270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Anthem Medicaid |
$197.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Humana Medicaid |
$197.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.93
|
| Rate for Payer: Molina Healthcare Passport |
$197.97
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.95
|
|
|
PRCRD DRG 6YR+ W/O CGEN CAR
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 33017
|
| Hospital Charge Code |
36001270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Anthem Medicaid |
$197.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Humana Medicaid |
$197.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$340.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.93
|
| Rate for Payer: Molina Healthcare Passport |
$197.97
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.95
|
|
|
PREALBUMIN
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
30000482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$119.04 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.57
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.44
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
PREALBUMIN
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
30000482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$119.04 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem Medicaid |
$14.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.59
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| Rate for Payer: Humana KY Medicaid |
$14.59
|
| Rate for Payer: Humana Medicare Advantage |
$14.59
|
| Rate for Payer: Kentucky WC Medicaid |
$14.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.44
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
PRECEDEX 20mcg SYR(from SDV)
|
Facility
|
OP
|
$78.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.36 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: Anthem Medicaid |
$27.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.23
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: Cigna Commercial |
$65.16
|
| Rate for Payer: First Health Commercial |
$74.58
|
| Rate for Payer: Humana Commercial |
$66.72
|
| Rate for Payer: Humana KY Medicaid |
$27.00
|
| Rate for Payer: Kentucky WC Medicaid |
$27.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.08
|
| Rate for Payer: Ohio Health Group HMO |
$58.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.34
|
| Rate for Payer: PHCS Commercial |
$75.36
|
| Rate for Payer: United Healthcare All Payer |
$69.08
|
|
|
PRECEDEX 20mcg SYR(from SDV)
|
Facility
|
IP
|
$78.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.36 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.23
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: Cigna Commercial |
$65.16
|
| Rate for Payer: First Health Commercial |
$74.58
|
| Rate for Payer: Humana Commercial |
$66.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.08
|
| Rate for Payer: Ohio Health Group HMO |
$58.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.34
|
| Rate for Payer: PHCS Commercial |
$75.36
|
| Rate for Payer: United Healthcare All Payer |
$69.08
|
|
