|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
OP
|
$117.86
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
636T0045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$113.15 |
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Anthem Medicaid |
$40.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cigna Commercial |
$97.82
|
| Rate for Payer: First Health Commercial |
$111.97
|
| Rate for Payer: Humana Commercial |
$100.18
|
| Rate for Payer: Humana KY Medicaid |
$40.53
|
| Rate for Payer: Kentucky WC Medicaid |
$40.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.72
|
| Rate for Payer: Ohio Health Group HMO |
$88.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.54
|
| Rate for Payer: PHCS Commercial |
$113.15
|
| Rate for Payer: United Healthcare All Payer |
$103.72
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
OP
|
$122.60
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
25002276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$117.70 |
| Rate for Payer: Aetna Commercial |
$94.40
|
| Rate for Payer: Anthem Medicaid |
$42.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.63
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: First Health Commercial |
$116.47
|
| Rate for Payer: Humana Commercial |
$104.21
|
| Rate for Payer: Humana KY Medicaid |
$42.16
|
| Rate for Payer: Kentucky WC Medicaid |
$42.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.89
|
| Rate for Payer: Ohio Health Group HMO |
$91.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.01
|
| Rate for Payer: PHCS Commercial |
$117.70
|
| Rate for Payer: United Healthcare All Payer |
$107.89
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Professional
|
Both
|
$117.86
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$117.86 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.86
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.42
|
| Rate for Payer: Multiplan PHCS |
$70.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.50
|
| Rate for Payer: UHCCP Medicaid |
$41.25
|
|
|
NORFLEX(ORPHENADRIN 100MG/1TAB
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 43386048024
|
| Hospital Charge Code |
25001097
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
NORFLEX(ORPHENADRIN 100MG/1TAB
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 43386048024
|
| Hospital Charge Code |
25001097
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
NORMAL NEWBORN
|
Facility
|
IP
|
$2,764.54
|
|
|
Service Code
|
MSDRG 795
|
| Min. Negotiated Rate |
$1,170.00 |
| Max. Negotiated Rate |
$2,764.54 |
| Rate for Payer: Anthem Medicaid |
$1,875.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,974.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,764.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,665.80
|
| Rate for Payer: Humana KY Medicaid |
$1,875.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,974.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,894.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.46
|
|
|
NORMODYNE 100MG/20ML VIAL
|
Facility
|
OP
|
$79.96
|
|
|
Service Code
|
NDC 409012501
|
| Hospital Charge Code |
25003301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$76.76 |
| Rate for Payer: Aetna Commercial |
$61.57
|
| Rate for Payer: Anthem Medicaid |
$27.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.37
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cigna Commercial |
$66.37
|
| Rate for Payer: First Health Commercial |
$75.96
|
| Rate for Payer: Humana Commercial |
$67.97
|
| Rate for Payer: Humana KY Medicaid |
$27.50
|
| Rate for Payer: Kentucky WC Medicaid |
$27.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.36
|
| Rate for Payer: Ohio Health Group HMO |
$59.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.79
|
| Rate for Payer: PHCS Commercial |
$76.76
|
| Rate for Payer: United Healthcare All Payer |
$70.36
|
|
|
NORMODYNE 100MG/20ML VIAL
|
Facility
|
IP
|
$79.96
|
|
|
Service Code
|
NDC 409012501
|
| Hospital Charge Code |
25003301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$76.76 |
| Rate for Payer: Aetna Commercial |
$61.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.37
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cigna Commercial |
$66.37
|
| Rate for Payer: First Health Commercial |
$75.96
|
| Rate for Payer: Humana Commercial |
$67.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.36
|
| Rate for Payer: Ohio Health Group HMO |
$59.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.79
|
| Rate for Payer: PHCS Commercial |
$76.76
|
| Rate for Payer: United Healthcare All Payer |
$70.36
|
|
|
NORMODYNE (LABETALO 200MG/1TAB
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
25001098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
NORMODYNE (LABETALO 200MG/1TAB
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
25001098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
NORMODYNE (LABETALOL) 100MGTAB
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
25001099
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
| Rate for Payer: Aetna Commercial |
$3.58
|
| 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 |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
|
|
NORMODYNE (LABETALOL) 100MGTAB
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
25001099
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
NORMOSOL-R(PH 7.4)IVSOL 1000ML
|
Facility
|
OP
|
$112.25
|
|
|
Service Code
|
NDC 990767009
|
| Hospital Charge Code |
25003302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem Medicaid |
$38.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Humana KY Medicaid |
$38.60
|
| Rate for Payer: Kentucky WC Medicaid |
$39.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
NORMOSOL-R(PH 7.4)IVSOL 1000ML
|
Facility
|
IP
|
$112.25
|
|
|
Service Code
|
NDC 990767009
|
| Hospital Charge Code |
25003302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
NORPACE (DISOPYRAMI 100MG/1CAP
|
Facility
|
OP
|
$9.99
|
|
|
Service Code
|
NDC 93312701
|
| Hospital Charge Code |
25001100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.79
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.29
|
| Rate for Payer: First Health Commercial |
$9.49
|
| Rate for Payer: Humana Commercial |
$8.49
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.79
|
| Rate for Payer: Ohio Health Group HMO |
$7.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Payer |
$8.79
|
|
|
NORPACE (DISOPYRAMI 100MG/1CAP
|
Facility
|
IP
|
$9.99
|
|
|
Service Code
|
NDC 93312701
|
| Hospital Charge Code |
25001100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.79
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.29
|
| Rate for Payer: First Health Commercial |
$9.49
|
| Rate for Payer: Humana Commercial |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.79
|
| Rate for Payer: Ohio Health Group HMO |
$7.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Payer |
$8.79
|
|
|
NORPACE (DISOPYRAMI 150MG/1CAP
|
Facility
|
OP
|
$10.25
|
|
|
Service Code
|
NDC 93312901
|
| Hospital Charge Code |
25001101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.51
|
| Rate for Payer: First Health Commercial |
$9.74
|
| Rate for Payer: Humana Commercial |
$8.71
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.02
|
| Rate for Payer: Ohio Health Group HMO |
$7.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Payer |
$9.02
|
|
|
NORPACE (DISOPYRAMI 150MG/1CAP
|
Facility
|
IP
|
$10.25
|
|
|
Service Code
|
NDC 93312901
|
| Hospital Charge Code |
25001101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.51
|
| Rate for Payer: First Health Commercial |
$9.74
|
| Rate for Payer: Humana Commercial |
$8.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.02
|
| Rate for Payer: Ohio Health Group HMO |
$7.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Payer |
$9.02
|
|
|
NORVASC AMLODIPINE 2.5MG TAB
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 29300039619
|
| Hospital Charge Code |
25001105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| 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 |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
NORVASC AMLODIPINE 2.5MG TAB
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 29300039619
|
| Hospital Charge Code |
25001105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| 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 |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| 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 |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
NORVASC (AMLODIPINE) 5MG/1TAB
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 60687048801
|
| Hospital Charge Code |
25001104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
NORVASC (AMLODIPINE) 5MG/1TAB
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 60687048801
|
| Hospital Charge Code |
25001104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
NORVASC(AMLODIPINE BESYL)10MGT
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 904637161
|
| Hospital Charge Code |
25001106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| 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 |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
NORVASC(AMLODIPINE BESYL)10MGT
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 904637161
|
| Hospital Charge Code |
25001106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| 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 |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
NORVIR 100MG CAPSULE
|
Facility
|
IP
|
$10.67
|
|
|
Service Code
|
NDC 31722059730
|
| Hospital Charge Code |
25001107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.32
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: First Health Commercial |
$10.14
|
| Rate for Payer: Humana Commercial |
$9.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.39
|
| Rate for Payer: Ohio Health Group HMO |
$8.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$10.24
|
| Rate for Payer: United Healthcare All Payer |
$9.39
|
|
