|
IR SPECIAL DEV PROC PER 15MIN
|
Facility
|
OP
|
$4,784.00
|
|
| Hospital Charge Code |
32000382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,435.20 |
| Max. Negotiated Rate |
$4,592.64 |
| Rate for Payer: Aetna Commercial |
$3,683.68
|
| Rate for Payer: Anthem Medicaid |
$1,645.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.52
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$3,970.72
|
| Rate for Payer: First Health Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial |
$4,066.40
|
| Rate for Payer: Humana KY Medicaid |
$1,645.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,678.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,162.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.96
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
|
IR SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75810
|
| Hospital Charge Code |
76102439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.72 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem Medicaid |
$1,075.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Humana KY Medicaid |
$1,075.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,502.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,721.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,158.32
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
IR SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75810
|
| Hospital Charge Code |
76102439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$938.40 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,502.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,721.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,158.32
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
IR TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
32000178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
IR TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
32000178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
OP
|
$72.72
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
25000793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$69.81 |
| Rate for Payer: Aetna Commercial |
$55.99
|
| Rate for Payer: Anthem Medicaid |
$25.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.72
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Cigna Commercial |
$60.36
|
| Rate for Payer: First Health Commercial |
$69.08
|
| Rate for Payer: Humana Commercial |
$61.81
|
| Rate for Payer: Humana KY Medicaid |
$25.01
|
| Rate for Payer: Kentucky WC Medicaid |
$25.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.99
|
| Rate for Payer: Ohio Health Group HMO |
$54.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.18
|
| Rate for Payer: PHCS Commercial |
$69.81
|
| Rate for Payer: United Healthcare All Payer |
$63.99
|
|
|
ISENTRESS 400 MG TABLET
|
Facility
|
IP
|
$72.72
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
25000793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$69.81 |
| Rate for Payer: Aetna Commercial |
$55.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.72
|
| Rate for Payer: Cash Price |
$36.36
|
| Rate for Payer: Cigna Commercial |
$60.36
|
| Rate for Payer: First Health Commercial |
$69.08
|
| Rate for Payer: Humana Commercial |
$61.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.99
|
| Rate for Payer: Ohio Health Group HMO |
$54.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.18
|
| Rate for Payer: PHCS Commercial |
$69.81
|
| Rate for Payer: United Healthcare All Payer |
$63.99
|
|
|
ISMO (ISOSORBIDE) 20 20MG/1TAB
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 228262011
|
| Hospital Charge Code |
25000794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| 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 |
$3.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.25
|
| 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 |
$1.41 |
| 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 |
$3.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.25
|
| 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 |
$23.40 |
| 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 |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| 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 |
$23.40 |
| 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 |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| 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 |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| 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 |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| 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 |
$1.33 |
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| 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 |
$1.33 |
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ISOPTIN SR(VERAPAMI 240MG/1TAB
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
25000798
|
|
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
|
|
|
ISOPTIN SR(VERAPAMI 240MG/1TAB
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68462026001
|
| Hospital Charge Code |
25000798
|
|
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
|
|
|
ISOPTIN (VERAPAMIL) 120MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 591034501
|
| Hospital Charge Code |
25000796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| 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 |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| 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 |
$1.27 |
| 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 |
$3.31
|
| 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 |
$1.27
|
| 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 |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| 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 |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| 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 |
$1.27
|
| 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 |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
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 |
$0.31 |
| 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 |
$0.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.72
|
| Rate for Payer: PHCS Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Payer |
$0.92
|
|
|
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 |
$0.31 |
| Max. Negotiated Rate |
$1.00 |
| 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
|
| 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 |
$0.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.72
|
| Rate for Payer: PHCS Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Payer |
$0.92
|
|
|
ISORDIL (ISOSORBIDE) 10MG/1TAB
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
25000800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| 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 |
$4.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ISORDIL (ISOSORBIDE) 10MG/1TAB
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
25000800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| 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 |
$4.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
