|
CORDARONE (AMIODARO 200MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
25000460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
CORDARONE (AMIODARO 200MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
25000460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
COREG (CARVEDILOL) 12.5MG/1TAB
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 51079093120
|
| Hospital Charge Code |
25000462
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
COREG (CARVEDILOL) 12.5MG/1TAB
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 51079093120
|
| Hospital Charge Code |
25000462
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
COREG (CARVEDILOL ) 25MG/1TAB
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 68001015200
|
| Hospital Charge Code |
25000461
|
|
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
|
|
|
COREG (CARVEDILOL ) 25MG/1TAB
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 68001015200
|
| Hospital Charge Code |
25000461
|
|
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
|
|
|
COREG (CARVELILOL) 3.13MG/1TAB
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 781522101
|
| Hospital Charge Code |
25000463
|
|
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
|
|
|
COREG (CARVELILOL) 3.13MG/1TAB
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 781522101
|
| Hospital Charge Code |
25000463
|
|
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
|
|
|
COREG (CARVELILOL) 6.25MG/1TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68084085401
|
| Hospital Charge Code |
25000464
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
COREG (CARVELILOL) 6.25MG/1TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68084085401
|
| Hospital Charge Code |
25000464
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
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 |
$753.10 |
| Rate for Payer: Ambetter Exchange |
$142.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.80
|
| Rate for Payer: Anthem Medicaid |
$738.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.47
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Humana Medicaid |
$738.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.10
|
| Rate for Payer: Molina Healthcare Passport |
$738.33
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.68
|
| Rate for Payer: UHCCP Medicaid |
$123.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$745.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.06
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$2,219.52 |
| Rate for Payer: Aetna Commercial |
$1,780.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,803.36
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cigna Commercial |
$1,918.96
|
| Rate for Payer: First Health Commercial |
$2,196.40
|
| Rate for Payer: Humana Commercial |
$1,965.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,895.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,706.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$693.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,734.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.28
|
| Rate for Payer: PHCS Commercial |
$2,219.52
|
| Rate for Payer: United Healthcare All Payer |
$2,034.56
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
OP
|
$2,122.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
761T1187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.76 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,633.94
|
| Rate for Payer: Anthem Medicaid |
$729.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,655.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,061.00
|
| Rate for Payer: Cash Price |
$1,061.00
|
| Rate for Payer: Cigna Commercial |
$1,761.26
|
| Rate for Payer: First Health Commercial |
$2,015.90
|
| Rate for Payer: Humana Commercial |
$1,803.70
|
| Rate for Payer: Humana KY Medicaid |
$729.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,740.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,566.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$744.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,867.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,591.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.18
|
| Rate for Payer: PHCS Commercial |
$2,037.12
|
| Rate for Payer: United Healthcare All Payer |
$1,867.36
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
IP
|
$2,122.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
761T1187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.60 |
| Max. Negotiated Rate |
$2,037.12 |
| Rate for Payer: Aetna Commercial |
$1,633.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,655.16
|
| Rate for Payer: Cash Price |
$1,061.00
|
| Rate for Payer: Cigna Commercial |
$1,761.26
|
| Rate for Payer: First Health Commercial |
$2,015.90
|
| Rate for Payer: Humana Commercial |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,740.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,566.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,867.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,591.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.18
|
| Rate for Payer: PHCS Commercial |
$2,037.12
|
| Rate for Payer: United Healthcare All Payer |
$1,867.36
|
|
|
CORE NDL BX LNG/MED PERQ
|
Professional
|
Both
|
$2,312.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Ambetter Exchange |
$142.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.80
|
| Rate for Payer: Anthem Medicaid |
$738.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.47
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Humana Medicaid |
$738.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.10
|
| Rate for Payer: Molina Healthcare Passport |
$738.33
|
| Rate for Payer: Multiplan PHCS |
$1,387.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.68
|
| Rate for Payer: UHCCP Medicaid |
$123.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$745.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.06
|
|
|
CORE NDL BX LNG/MED PERQ
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
76101187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.10 |
| Max. Negotiated Rate |
$2,219.52 |
| Rate for Payer: Aetna Commercial |
$1,780.24
|
| Rate for Payer: Anthem Medicaid |
$795.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,803.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cigna Commercial |
$1,918.96
|
| Rate for Payer: First Health Commercial |
$2,196.40
|
| Rate for Payer: Humana Commercial |
$1,965.20
|
| Rate for Payer: Humana KY Medicaid |
$795.10
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$803.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,895.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,706.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$811.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,734.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.28
|
| Rate for Payer: PHCS Commercial |
$2,219.52
|
| Rate for Payer: United Healthcare All Payer |
$2,034.56
|
|
|
CORGARD 20MG TABLET
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
NDC 68001031700
|
| Hospital Charge Code |
25000470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| 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 |
$7.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.79
|
| 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 |
$2.95 |
| 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 |
$7.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.79
|
| Rate for Payer: PHCS Commercial |
$9.45
|
| Rate for Payer: United Healthcare All Payer |
$8.66
|
|
|
CORGARD (NADOLOL) 40 40MG/1TAB
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
25000469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
CORGARD (NADOLOL) 40 40MG/1TAB
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
25000469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
CORIAL FEM SSTEM WO CLR SZ11
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM SSTEM WO CLR SZ11
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM W/0 CLR SZ20
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM W/0 CLR SZ20
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM W/ COLLR SZ 15
|
Facility
|
IP
|
$21,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,449.10 |
| Max. Negotiated Rate |
$20,637.12 |
| Rate for Payer: Aetna Commercial |
$16,552.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,767.66
|
| Rate for Payer: Cash Price |
$10,748.50
|
| Rate for Payer: Cigna Commercial |
$17,842.51
|
| Rate for Payer: First Health Commercial |
$20,422.15
|
| Rate for Payer: Humana Commercial |
$18,272.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,627.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,864.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,917.36
|
| Rate for Payer: Ohio Health Group HMO |
$16,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,702.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,832.93
|
| Rate for Payer: PHCS Commercial |
$20,637.12
|
| Rate for Payer: United Healthcare All Payer |
$18,917.36
|
|
