|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$17,392.90
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$11,802.32 |
| Max. Negotiated Rate |
$17,392.90 |
| Rate for Payer: Anthem Medicaid |
$11,802.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,392.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,771.72
|
| Rate for Payer: Humana KY Medicaid |
$11,802.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,423.50
|
| Rate for Payer: Kentucky WC Medicaid |
$11,920.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,908.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,038.37
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
IP
|
$71.28
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
25000793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$68.43 |
| Rate for Payer: Aetna Commercial |
$54.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.60
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cigna Commercial |
$59.16
|
| Rate for Payer: First Health Commercial |
$67.72
|
| Rate for Payer: Humana Commercial |
$60.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.73
|
| Rate for Payer: Ohio Health Group HMO |
$53.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.10
|
| Rate for Payer: PHCS Commercial |
$68.43
|
| Rate for Payer: United Healthcare All Payer |
$62.73
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
OP
|
$71.28
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
25000793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$68.43 |
| Rate for Payer: Aetna Commercial |
$54.89
|
| Rate for Payer: Anthem Medicaid |
$24.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.60
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cigna Commercial |
$59.16
|
| Rate for Payer: First Health Commercial |
$67.72
|
| Rate for Payer: Humana Commercial |
$60.59
|
| Rate for Payer: Humana KY Medicaid |
$24.51
|
| Rate for Payer: Kentucky WC Medicaid |
$24.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.73
|
| Rate for Payer: Ohio Health Group HMO |
$53.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.10
|
| Rate for Payer: PHCS Commercial |
$68.43
|
| Rate for Payer: United Healthcare All Payer |
$62.73
|
|
|
ISMO (ISOSORBIDE) 20 20MG/1TAB
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 228262011
|
| Hospital Charge Code |
25000794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.91
|
| Rate for Payer: First Health Commercial |
$4.47
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
ISMO (ISOSORBIDE) 20 20MG/1TAB
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 228262011
|
| Hospital Charge Code |
25000794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.91
|
| Rate for Payer: First Health Commercial |
$4.47
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
ISOFLURANE INH 250 ML
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
25003845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
ISOFLURANE INH 250 ML
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
25003845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
ISONIAZID 100 MG TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 555006602
|
| Hospital Charge Code |
25003129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
ISONIAZID 100 MG TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 555006602
|
| Hospital Charge Code |
25003129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
ISOPTIN SR(VERAPAMI 180MG/1TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 75834015801
|
| Hospital Charge Code |
25000797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| 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 |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ISOPTIN SR(VERAPAMI 180MG/1TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 75834015801
|
| Hospital Charge Code |
25000797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| 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 |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ISOPTIN SR(VERAPAMI 240MG/1TAB
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
25000798
|
|
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
|
|
|
ISOPTIN SR(VERAPAMI 240MG/1TAB
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
25000798
|
|
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
|
|
|
ISOPTIN (VERAPAMIL) 120MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 591034501
|
| Hospital Charge Code |
25000796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ISOPTIN (VERAPAMIL) 120MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 591034501
|
| Hospital Charge Code |
25000796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ISOPTIN (VERAPAMIL) 80MG/1TAB
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 591034301
|
| Hospital Charge Code |
25000795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
ISOPTIN (VERAPAMIL) 80MG/1TAB
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 591034301
|
| Hospital Charge Code |
25000795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
ISOPTO CARPINE 2% OPHTH S 15ML
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 70069019101
|
| Hospital Charge Code |
25000799
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.92
|
| Rate for Payer: Ohio Health Group HMO |
$0.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Payer |
$0.92
|
| Rate for Payer: Aetna Commercial |
$0.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.81
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.86
|
| Rate for Payer: First Health Commercial |
$0.99
|
|
|
ISOPTO CARPINE 2% OPHTH S 15ML
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 70069019101
|
| Hospital Charge Code |
25000799
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.80
|
| Rate for Payer: Anthem Medicaid |
$0.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.81
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.86
|
| Rate for Payer: First Health Commercial |
$0.99
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana KY Medicaid |
$0.36
|
| Rate for Payer: Kentucky WC Medicaid |
$0.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.92
|
| Rate for Payer: Ohio Health Group HMO |
$0.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Payer |
$0.92
|
|
|
ISORDIL (ISOSORBIDE) 10MG/1TAB
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
25000800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Anthem Medicaid |
$1.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.26
|
| Rate for Payer: First Health Commercial |
$4.87
|
| Rate for Payer: Humana Commercial |
$4.36
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ISORDIL (ISOSORBIDE) 10MG/1TAB
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
25000800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.26
|
| Rate for Payer: First Health Commercial |
$4.87
|
| Rate for Payer: Humana Commercial |
$4.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ISORDIL (ISOSORBIDE) 20MG/1TAB
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
25000801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.24
|
| Rate for Payer: First Health Commercial |
$4.85
|
| Rate for Payer: Humana Commercial |
$4.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.50
|
| Rate for Payer: Ohio Health Group HMO |
$3.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.58
|
| Rate for Payer: PHCS Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Payer |
$4.50
|
|
|
ISORDIL (ISOSORBIDE) 20MG/1TAB
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 68084008301
|
| Hospital Charge Code |
25000801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Anthem Medicaid |
$1.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.24
|
| Rate for Payer: First Health Commercial |
$4.85
|
| Rate for Payer: Humana Commercial |
$4.34
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.50
|
| Rate for Payer: Ohio Health Group HMO |
$3.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.58
|
| Rate for Payer: PHCS Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Payer |
$4.50
|
|
|
ISORDIL (ISOSORBIDE) 5MG/1TAB
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 50268044715
|
| Hospital Charge Code |
25000802
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.22
|
| Rate for Payer: First Health Commercial |
$4.84
|
| Rate for Payer: Humana Commercial |
$4.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.48
|
| Rate for Payer: Ohio Health Group HMO |
$3.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.58
|
| Rate for Payer: PHCS Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Payer |
$4.48
|
|
|
ISORDIL (ISOSORBIDE) 5MG/1TAB
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 50268044715
|
| Hospital Charge Code |
25000802
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Anthem Medicaid |
$1.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.22
|
| Rate for Payer: First Health Commercial |
$4.84
|
| Rate for Payer: Humana Commercial |
$4.33
|
| Rate for Payer: Humana KY Medicaid |
$1.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.48
|
| Rate for Payer: Ohio Health Group HMO |
$3.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.58
|
| Rate for Payer: PHCS Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Payer |
$4.48
|
|
