|
PROAMATINE(MIDODRINE)2.5MG TAB
|
Facility
|
IP
|
$5.18
|
|
|
Service Code
|
NDC 60687038701
|
| Hospital Charge Code |
25001240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.04
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna Commercial |
$4.30
|
| Rate for Payer: First Health Commercial |
$4.92
|
| Rate for Payer: Humana Commercial |
$4.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.56
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Payer |
$4.56
|
|
|
PROAMATINE(MIDODRINE)2.5MG TAB
|
Facility
|
OP
|
$5.18
|
|
|
Service Code
|
NDC 60687038701
|
| Hospital Charge Code |
25001240
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.04
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna Commercial |
$4.30
|
| Rate for Payer: First Health Commercial |
$4.92
|
| Rate for Payer: Humana Commercial |
$4.40
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.56
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Payer |
$4.56
|
|
|
PROAMATINE (MIDODRINE 5MG TAB)
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
25001239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROAMATINE (MIDODRINE 5MG TAB)
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
25001239
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
PROBE 0.8MM 840-731DISP
|
Facility
|
OP
|
$2,113.10
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.70 |
| Max. Negotiated Rate |
$2,028.58 |
| Rate for Payer: Aetna Commercial |
$1,627.09
|
| Rate for Payer: Anthem Medicaid |
$726.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.22
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cigna Commercial |
$1,753.87
|
| Rate for Payer: First Health Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial |
$1,796.14
|
| Rate for Payer: Humana KY Medicaid |
$726.70
|
| Rate for Payer: Kentucky WC Medicaid |
$734.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,559.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,859.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.06
|
| Rate for Payer: PHCS Commercial |
$2,028.58
|
| Rate for Payer: United Healthcare All Payer |
$1,859.53
|
|
|
PROBE 0.8MM 840-731DISP
|
Facility
|
IP
|
$2,113.10
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.70 |
| Max. Negotiated Rate |
$2,028.58 |
| Rate for Payer: Aetna Commercial |
$1,627.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.22
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cigna Commercial |
$1,753.87
|
| Rate for Payer: First Health Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial |
$1,796.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,559.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,859.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.06
|
| Rate for Payer: PHCS Commercial |
$2,028.58
|
| Rate for Payer: United Healthcare All Payer |
$1,859.53
|
|
|
PROBE SHEATH F/UM-BS20-26R
|
Facility
|
OP
|
$2,033.76
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.39 |
| Max. Negotiated Rate |
$1,952.41 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Anthem Medicaid |
$699.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.33
|
| Rate for Payer: Cash Price |
$1,016.88
|
| Rate for Payer: Cigna Commercial |
$1,688.02
|
| Rate for Payer: First Health Commercial |
$1,932.07
|
| Rate for Payer: Humana Commercial |
$1,728.70
|
| Rate for Payer: Humana KY Medicaid |
$699.41
|
| Rate for Payer: Kentucky WC Medicaid |
$706.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.47
|
| Rate for Payer: PHCS Commercial |
$1,952.41
|
| Rate for Payer: United Healthcare All Payer |
$1,789.71
|
|
|
PROBE SHEATH F/UM-BS20-26R
|
Facility
|
IP
|
$2,033.76
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.39 |
| Max. Negotiated Rate |
$1,952.41 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.33
|
| Rate for Payer: Cash Price |
$1,016.88
|
| Rate for Payer: Cigna Commercial |
$1,688.02
|
| Rate for Payer: First Health Commercial |
$1,932.07
|
| Rate for Payer: Humana Commercial |
$1,728.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.47
|
| Rate for Payer: PHCS Commercial |
$1,952.41
|
| Rate for Payer: United Healthcare All Payer |
$1,789.71
|
|
|
PROCALCITONIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$27.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.22
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$27.22
|
| Rate for Payer: Humana Medicare Advantage |
$27.22
|
| Rate for Payer: Kentucky WC Medicaid |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.02
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
PROCALCITONIN
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna Commercial |
$44.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$145.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$169.40
|
| Rate for Payer: UHCCP Medicaid |
$84.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.33
|
|
|
PROCALCITONIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
30000485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.02
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
PROCARDIA (NIFEDIPIN 10MG/1CAP
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 69315021101
|
| Hospital Charge Code |
25001242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PROCARDIA (NIFEDIPIN 10MG/1CAP
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 69315021101
|
| Hospital Charge Code |
25001242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PROCARDIA XL (NIFEDI 90MG/1TAB
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 50742026201
|
| Hospital Charge Code |
25001243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
PROCARDIA XL (NIFEDI 90MG/1TAB
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 50742026201
|
| Hospital Charge Code |
25001243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.87
|
| Rate for Payer: First Health Commercial |
$4.43
|
| Rate for Payer: Humana Commercial |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.10
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Payer |
$4.10
|
|
|
PROCARDIA XL(NIFEDIP 30MG/1TAB
|
Facility
|
IP
|
$9.49
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
25001244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
|
|
PROCARDIA XL(NIFEDIP 30MG/1TAB
|
Facility
|
OP
|
$9.49
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
25001244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem Medicaid |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Humana KY Medicaid |
$3.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
|
|
PROCARDIA XL(NIFEDIP 60MG/1TAB
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 67877075801
|
| Hospital Charge Code |
25001245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
PROCARDIA XL(NIFEDIP 60MG/1TAB
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 67877075801
|
| Hospital Charge Code |
25001245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
PROCRIT 1000U 10000U/ML VIAL
|
Facility
|
IP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.34 |
| Max. Negotiated Rate |
$1,398.20 |
| Rate for Payer: Aetna Commercial |
$1,121.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.04
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cigna Commercial |
$1,208.86
|
| Rate for Payer: First Health Commercial |
$1,383.64
|
| Rate for Payer: Humana Commercial |
$1,237.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$436.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.50
|
| Rate for Payer: PHCS Commercial |
$1,398.20
|
| Rate for Payer: United Healthcare All Payer |
$1,281.68
|
|
|
PROCRIT 1000U 10000U/ML VIAL
|
Facility
|
OP
|
$1,456.46
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$1,398.20 |
| Rate for Payer: Aetna Commercial |
$1,121.47
|
| Rate for Payer: Anthem Medicaid |
$500.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,136.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cash Price |
$728.23
|
| Rate for Payer: Cigna Commercial |
$1,208.86
|
| Rate for Payer: First Health Commercial |
$1,383.64
|
| Rate for Payer: Humana Commercial |
$1,237.99
|
| Rate for Payer: Humana KY Medicaid |
$500.88
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$505.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,194.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$510.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,281.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,092.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.50
|
| Rate for Payer: PHCS Commercial |
$1,398.20
|
| Rate for Payer: United Healthcare All Payer |
$1,281.68
|
|
|
PROCRIT 1000 UN (40000 UN VL)
|
Facility
|
OP
|
$5,826.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$5,593.01 |
| Rate for Payer: Aetna Commercial |
$4,486.06
|
| Rate for Payer: Anthem Medicaid |
$2,003.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cigna Commercial |
$4,835.62
|
| Rate for Payer: First Health Commercial |
$5,534.75
|
| Rate for Payer: Humana Commercial |
$4,952.14
|
| Rate for Payer: Humana KY Medicaid |
$2,003.58
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,023.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,043.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,126.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.08
|
| Rate for Payer: PHCS Commercial |
$5,593.01
|
| Rate for Payer: United Healthcare All Payer |
$5,126.92
|
|
|
PROCRIT 1000 UN (40000 UN VL)
|
Facility
|
IP
|
$5,826.05
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$757.39 |
| Max. Negotiated Rate |
$5,593.01 |
| Rate for Payer: Aetna Commercial |
$4,486.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.32
|
| Rate for Payer: Cash Price |
$2,913.02
|
| Rate for Payer: Cigna Commercial |
$4,835.62
|
| Rate for Payer: First Health Commercial |
$5,534.75
|
| Rate for Payer: Humana Commercial |
$4,952.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,747.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,126.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.08
|
| Rate for Payer: PHCS Commercial |
$5,593.01
|
| Rate for Payer: United Healthcare All Payer |
$5,126.92
|
|
|
PROCRIT1000UNIT[4000UNIT/ML VL
|
Facility
|
OP
|
$582.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem Medicaid |
$200.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$483.57
|
| Rate for Payer: First Health Commercial |
$553.48
|
| Rate for Payer: Humana Commercial |
$495.22
|
| Rate for Payer: Humana KY Medicaid |
$200.36
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$202.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.70
|
| Rate for Payer: Ohio Health Group HMO |
$436.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.61
|
| Rate for Payer: PHCS Commercial |
$559.31
|
| Rate for Payer: United Healthcare All Payer |
$512.70
|
|
|
PROCRIT1000UNIT[4000UNIT/ML VL
|
Facility
|
IP
|
$582.61
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
25001994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$448.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$454.44
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$483.57
|
| Rate for Payer: First Health Commercial |
$553.48
|
| Rate for Payer: Humana Commercial |
$495.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.70
|
| Rate for Payer: Ohio Health Group HMO |
$436.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.61
|
| Rate for Payer: PHCS Commercial |
$559.31
|
| Rate for Payer: United Healthcare All Payer |
$512.70
|
|
