|
COREG (CARVEDILOL) 12.5MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 904630261
|
| Hospital Charge Code |
25000462
|
|
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
|
|
|
COREG (CARVEDILOL ) 25MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 68001015200
|
| Hospital Charge Code |
25000461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| 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
|
| Rate for Payer: Aetna Commercial |
$3.30
|
|
|
COREG (CARVEDILOL ) 25MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68001015200
|
| Hospital Charge Code |
25000461
|
|
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
|
|
|
COREG (CARVELILOL) 3.13MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 904630061
|
| Hospital Charge Code |
25000463
|
|
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
|
|
|
COREG (CARVELILOL) 3.13MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 904630061
|
| Hospital Charge Code |
25000463
|
|
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
|
|
|
COREG (CARVELILOL) 6.25MG/1TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68084085401
|
| Hospital Charge Code |
25000464
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
COREG (CARVELILOL) 6.25MG/1TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68084085401
|
| Hospital Charge Code |
25000464
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
761T1187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
761T1187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem Medicaid |
$770.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Humana KY Medicaid |
$770.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$785.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.40
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.40
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
CORE NDL BX LNG/MED PERQ
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
761P1187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.80
|
| Rate for Payer: Anthem Medicaid |
$123.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Humana Medicaid |
$123.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.13
|
| Rate for Payer: Molina Healthcare Passport |
$123.66
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.00
|
| Rate for Payer: UHCCP Medicaid |
$123.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.90
|
|
|
CORE NDL BX LNG/MED PERQ
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.80
|
| Rate for Payer: Anthem Medicaid |
$123.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,240.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Humana Medicaid |
$123.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.13
|
| Rate for Payer: Molina Healthcare Passport |
$123.66
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,568.00
|
| Rate for Payer: UHCCP Medicaid |
$123.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.90
|
|
|
CORGARD 20MG TABLET
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
NDC 68001031700
|
| Hospital Charge Code |
25000470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna Commercial |
$8.17
|
| Rate for Payer: First Health Commercial |
$9.35
|
| Rate for Payer: Humana Commercial |
$8.36
|
| Rate for Payer: Humana KY Medicaid |
$3.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.66
|
| Rate for Payer: Ohio Health Group HMO |
$7.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$9.45
|
| Rate for Payer: United Healthcare All Payer |
$8.66
|
|
|
CORGARD 20MG TABLET
|
Facility
|
IP
|
$9.84
|
|
|
Service Code
|
NDC 68001031700
|
| Hospital Charge Code |
25000470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna Commercial |
$8.17
|
| Rate for Payer: First Health Commercial |
$9.35
|
| Rate for Payer: Humana Commercial |
$8.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.66
|
| Rate for Payer: Ohio Health Group HMO |
$7.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$9.45
|
| Rate for Payer: United Healthcare All Payer |
$8.66
|
|
|
CORGARD (NADOLOL) 40 40MG/1TAB
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
25000469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
CORGARD (NADOLOL) 40 40MG/1TAB
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
25000469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
CORIAL FEM SSTEM WO CLR SZ11
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM SSTEM WO CLR SZ11
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM STEM W/0 CLR SZ20
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM STEM W/0 CLR SZ20
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM STEM W/ COLLR SZ 15
|
Facility
|
IP
|
$20,857.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.42 |
| Max. Negotiated Rate |
$20,022.80 |
| Rate for Payer: Aetna Commercial |
$16,059.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,268.52
|
| Rate for Payer: Cash Price |
$10,428.54
|
| Rate for Payer: Cigna Commercial |
$17,311.38
|
| Rate for Payer: First Health Commercial |
$19,814.23
|
| Rate for Payer: Humana Commercial |
$17,728.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,102.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,392.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,257.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,354.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,642.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,171.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,465.69
|
| Rate for Payer: PHCS Commercial |
$20,022.80
|
| Rate for Payer: United Healthcare All Payer |
$18,354.23
|
|
|
CORIAL FEM STEM W/ COLLR SZ 15
|
Facility
|
OP
|
$20,857.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.42 |
| Max. Negotiated Rate |
$20,022.80 |
| Rate for Payer: Aetna Commercial |
$16,059.95
|
| Rate for Payer: Anthem Medicaid |
$7,172.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,268.52
|
| Rate for Payer: Cash Price |
$10,428.54
|
| Rate for Payer: Cigna Commercial |
$17,311.38
|
| Rate for Payer: First Health Commercial |
$19,814.23
|
| Rate for Payer: Humana Commercial |
$17,728.52
|
| Rate for Payer: Humana KY Medicaid |
$7,172.75
|
| Rate for Payer: Kentucky WC Medicaid |
$7,245.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,102.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,392.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,257.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,316.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,354.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,642.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,171.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,465.69
|
| Rate for Payer: PHCS Commercial |
$20,022.80
|
| Rate for Payer: United Healthcare All Payer |
$18,354.23
|
|
|
CORIAL FEM STEM WO COLLAR SZ12
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM STEM WO COLLAR SZ12
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
