|
PPIL VAG DEL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
76102245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$497.61
|
| Rate for Payer: Ambetter Exchange |
$318.36
|
| Rate for Payer: Anthem Medicaid |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.03
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$490.00
|
| Rate for Payer: Healthspan PPO |
$481.82
|
| Rate for Payer: Humana Medicaid |
$234.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.68
|
| Rate for Payer: Molina Healthcare Passport |
$234.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.87
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.36
|
|
|
PPIL VAG DEL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
76102245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
PPIL VAG DEL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
761P2245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$497.61
|
| Rate for Payer: Ambetter Exchange |
$318.36
|
| Rate for Payer: Anthem Medicaid |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.03
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$490.00
|
| Rate for Payer: Healthspan PPO |
$481.82
|
| Rate for Payer: Humana Medicaid |
$234.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.68
|
| Rate for Payer: Molina Healthcare Passport |
$234.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.87
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.36
|
|
|
PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
50000189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$168.79 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Ambetter Exchange |
$121.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.51
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$121.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.26
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.64
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.26
|
|
|
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 |
$168.79 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Ambetter Exchange |
$121.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.51
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$121.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.26
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.64
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.26
|
|
|
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 |
$105.00 |
| 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
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Facility
|
OP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem Medicaid |
$187.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Humana KY Medicaid |
$187.45
|
| Rate for Payer: Kentucky WC Medicaid |
$189.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.11
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Facility
|
IP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.11
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM
|
Professional
|
Both
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
77000046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$327.05 |
| Rate for Payer: Ambetter Exchange |
$133.47
|
| Rate for Payer: Anthem Medicaid |
$133.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Healthspan PPO |
$40.14
|
| Rate for Payer: Humana Medicaid |
$133.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.14
|
| Rate for Payer: Molina Healthcare Passport |
$133.47
|
| Rate for Payer: Multiplan PHCS |
$327.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.51
|
| Rate for Payer: UHCCP Medicaid |
$190.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.47
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM(T
|
Facility
|
IP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
770T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.11
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
PPSV23 VACC 2 YRS+ SUBQ/IM(T
|
Facility
|
OP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
770T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem Medicaid |
$187.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Humana KY Medicaid |
$187.45
|
| Rate for Payer: Kentucky WC Medicaid |
$189.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.11
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
PRADAXA 150MG CAPSULE
|
Facility
|
IP
|
$11.31
|
|
|
Service Code
|
NDC 597036082
|
| Hospital Charge Code |
25001206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| 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 |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$10.86
|
| Rate for Payer: United Healthcare All Payer |
$9.95
|
|
|
PRADAXA 150MG CAPSULE
|
Facility
|
OP
|
$11.31
|
|
|
Service Code
|
NDC 597036082
|
| Hospital Charge Code |
25001206
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| 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 |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| 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 |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| 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 |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
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 |
$1.32 |
| 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 |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| 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 |
$1.35 |
| 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 |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| 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 |
$1.35 |
| 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 |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| 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 |
$1.34 |
| 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 |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| 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 |
$1.34 |
| 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 |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| 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 |
$1.38 |
| 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 |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| 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 |
$1.38 |
| 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 |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
PRAXBIND 2.5GM/50ML VIAL
|
Facility
|
IP
|
$4,301.21
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,290.36 |
| Max. Negotiated Rate |
$4,129.16 |
| Rate for Payer: Aetna Commercial |
$3,311.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.94
|
| Rate for Payer: Cash Price |
$2,150.60
|
| Rate for Payer: Cigna Commercial |
$3,570.00
|
| Rate for Payer: First Health Commercial |
$4,086.15
|
| Rate for Payer: Humana Commercial |
$3,656.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,785.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,742.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.83
|
| Rate for Payer: PHCS Commercial |
$4,129.16
|
| Rate for Payer: United Healthcare All Payer |
$3,785.06
|
|
|
PRAXBIND 2.5GM/50ML VIAL
|
Facility
|
OP
|
$4,301.21
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,290.36 |
| Max. Negotiated Rate |
$4,129.16 |
| Rate for Payer: Aetna Commercial |
$3,311.93
|
| Rate for Payer: Anthem Medicaid |
$1,479.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.94
|
| Rate for Payer: Cash Price |
$2,150.60
|
| Rate for Payer: Cigna Commercial |
$3,570.00
|
| Rate for Payer: First Health Commercial |
$4,086.15
|
| Rate for Payer: Humana Commercial |
$3,656.03
|
| Rate for Payer: Humana KY Medicaid |
$1,479.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,494.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,785.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,742.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.83
|
| Rate for Payer: PHCS Commercial |
$4,129.16
|
| Rate for Payer: United Healthcare All Payer |
$3,785.06
|
|
|
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 |
$340.81 |
| Rate for Payer: Ambetter Exchange |
$230.97
|
| Rate for Payer: Anthem Medicaid |
$197.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$277.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$230.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.97
|
| 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 |
$300.26
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.97
|
|
|
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 |
$340.81 |
| Rate for Payer: Ambetter Exchange |
$230.97
|
| Rate for Payer: Anthem Medicaid |
$197.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$277.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$230.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.97
|
| 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 |
$300.26
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.97
|
|
