|
TOPAMAX(TOPIRAMATE) 50MG CAP
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 68462015360
|
| Hospital Charge Code |
25001566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| 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 |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
TOPAMAX(TOPI)SPRINKLE 15MG CAP
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
NDC 68382000414
|
| Hospital Charge Code |
25001565
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$6.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.63
|
| Rate for Payer: Humana Commercial |
$7.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.99
|
| Rate for Payer: Ohio Health Group HMO |
$6.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Payer |
$7.99
|
|
|
TOPAMAX(TOPI)SPRINKLE 15MG CAP
|
Facility
|
OP
|
$9.08
|
|
|
Service Code
|
NDC 68382000414
|
| Hospital Charge Code |
25001565
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$6.99
|
| Rate for Payer: Anthem Medicaid |
$3.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.63
|
| Rate for Payer: Humana Commercial |
$7.72
|
| Rate for Payer: Humana KY Medicaid |
$3.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.99
|
| Rate for Payer: Ohio Health Group HMO |
$6.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.72
|
| Rate for Payer: United Healthcare All Payer |
$7.99
|
|
|
TOPROL 50MG TAB
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 60687040201
|
| Hospital Charge Code |
25001574
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| 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 |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
TOPROL 50MG TAB
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 60687040201
|
| Hospital Charge Code |
25001574
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| 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 |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
TOPROL-XL (METOPR SUCC) 25MG T
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
25001575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| 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 |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
TOPROL-XL (METOPR SUCC) 25MG T
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
25001575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| 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 |
$1.60
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
IP
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$35.88 |
| Rate for Payer: Aetna Commercial |
$28.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.16
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cigna Commercial |
$31.03
|
| Rate for Payer: First Health Commercial |
$35.51
|
| Rate for Payer: Humana Commercial |
$31.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.89
|
| Rate for Payer: Ohio Health Group HMO |
$28.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.59
|
| Rate for Payer: PHCS Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Payer |
$32.89
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
OP
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$35.88 |
| Rate for Payer: Aetna Commercial |
$28.78
|
| Rate for Payer: Anthem Medicaid |
$12.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.16
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cigna Commercial |
$31.03
|
| Rate for Payer: First Health Commercial |
$35.51
|
| Rate for Payer: Humana Commercial |
$31.77
|
| Rate for Payer: Humana KY Medicaid |
$12.85
|
| Rate for Payer: Kentucky WC Medicaid |
$12.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.89
|
| Rate for Payer: Ohio Health Group HMO |
$28.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.59
|
| Rate for Payer: PHCS Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Payer |
$32.89
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Professional
|
Both
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$37.38 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.38
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Multiplan PHCS |
$22.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.17
|
| Rate for Payer: UHCCP Medicaid |
$13.08
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Professional
|
Both
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$37.38 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.38
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Multiplan PHCS |
$22.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.17
|
| Rate for Payer: UHCCP Medicaid |
$13.08
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
OP
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$35.88 |
| Rate for Payer: Aetna Commercial |
$28.78
|
| Rate for Payer: Anthem Medicaid |
$12.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.16
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cigna Commercial |
$31.03
|
| Rate for Payer: First Health Commercial |
$35.51
|
| Rate for Payer: Humana Commercial |
$31.77
|
| Rate for Payer: Humana KY Medicaid |
$12.85
|
| Rate for Payer: Kentucky WC Medicaid |
$12.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.89
|
| Rate for Payer: Ohio Health Group HMO |
$28.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.59
|
| Rate for Payer: PHCS Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Payer |
$32.89
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
IP
|
$77.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.64
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.10
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
IP
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$35.88 |
| Rate for Payer: Aetna Commercial |
$28.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.16
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cigna Commercial |
$31.03
|
| Rate for Payer: First Health Commercial |
$35.51
|
| Rate for Payer: Humana Commercial |
$31.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.89
|
| Rate for Payer: Ohio Health Group HMO |
$28.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.59
|
| Rate for Payer: PHCS Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Payer |
$32.89
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
OP
|
$77.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem Medicaid |
$26.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.64
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Humana KY Medicaid |
$26.74
|
| Rate for Payer: Kentucky WC Medicaid |
$27.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.10
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$77.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$74.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Anthem Medicaid |
$26.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.25
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: First Health Commercial |
$73.38
|
| Rate for Payer: Humana Commercial |
$65.65
|
| Rate for Payer: Humana KY Medicaid |
$26.56
|
| Rate for Payer: Kentucky WC Medicaid |
$26.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.97
|
| Rate for Payer: Ohio Health Group HMO |
$57.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.94
|
| Rate for Payer: PHCS Commercial |
$74.15
|
| Rate for Payer: United Healthcare All Payer |
$67.97
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$74.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$71.27 |
| Rate for Payer: Aetna Commercial |
$57.16
|
| Rate for Payer: Anthem Medicaid |
$25.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.91
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna Commercial |
$61.62
|
| Rate for Payer: First Health Commercial |
$70.53
|
| Rate for Payer: Humana Commercial |
$63.10
|
| Rate for Payer: Humana KY Medicaid |
$25.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.33
|
| Rate for Payer: Ohio Health Group HMO |
$55.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.01
|
| Rate for Payer: PHCS Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Payer |
$65.33
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$77.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$74.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.25
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: First Health Commercial |
$73.38
|
| Rate for Payer: Humana Commercial |
$65.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.97
|
| Rate for Payer: Ohio Health Group HMO |
$57.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.94
|
| Rate for Payer: PHCS Commercial |
$74.15
|
| Rate for Payer: United Healthcare All Payer |
$67.97
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$74.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$71.27 |
| Rate for Payer: Aetna Commercial |
$57.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.91
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna Commercial |
$61.62
|
| Rate for Payer: First Health Commercial |
$70.53
|
| Rate for Payer: Humana Commercial |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.33
|
| Rate for Payer: Ohio Health Group HMO |
$55.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.01
|
| Rate for Payer: PHCS Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Payer |
$65.33
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$74.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$71.27 |
| Rate for Payer: Aetna Commercial |
$57.16
|
| Rate for Payer: Anthem Medicaid |
$25.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.91
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna Commercial |
$61.62
|
| Rate for Payer: First Health Commercial |
$70.53
|
| Rate for Payer: Humana Commercial |
$63.10
|
| Rate for Payer: Humana KY Medicaid |
$25.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.33
|
| Rate for Payer: Ohio Health Group HMO |
$55.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.01
|
| Rate for Payer: PHCS Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Payer |
$65.33
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$74.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$71.27 |
| Rate for Payer: Aetna Commercial |
$57.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.91
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna Commercial |
$61.62
|
| Rate for Payer: First Health Commercial |
$70.53
|
| Rate for Payer: Humana Commercial |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.33
|
| Rate for Payer: Ohio Health Group HMO |
$55.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.01
|
| Rate for Payer: PHCS Commercial |
$71.27
|
| Rate for Payer: United Healthcare All Payer |
$65.33
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Professional
|
Both
|
$74.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$74.24 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.24
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Multiplan PHCS |
$44.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.97
|
| Rate for Payer: UHCCP Medicaid |
$25.98
|
|
|
TORADOL(KETOROLAC TR 10MG/1TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 35573045002
|
| Hospital Charge Code |
25001576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.90
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
TORADOL(KETOROLAC TR 10MG/1TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 35573045002
|
| Hospital Charge Code |
25001576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.90
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
TORISEL 1 MG (25MG VIAL)
|
Facility
|
IP
|
$32,705.23
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
25002682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,251.68 |
| Max. Negotiated Rate |
$31,397.02 |
| Rate for Payer: Aetna Commercial |
$25,183.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,510.08
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cigna Commercial |
$27,145.34
|
| Rate for Payer: First Health Commercial |
$31,069.97
|
| Rate for Payer: Humana Commercial |
$27,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,818.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,811.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,780.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,528.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,541.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,251.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,138.62
|
| Rate for Payer: PHCS Commercial |
$31,397.02
|
| Rate for Payer: United Healthcare All Payer |
$28,780.60
|
|
