|
METHERGINE(METHYLERG .2MG/1TAB
|
Facility
|
IP
|
$125.78
|
|
|
Service Code
|
NDC 54063905
|
| Hospital Charge Code |
25000971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$96.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.11
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cigna Commercial |
$104.40
|
| Rate for Payer: First Health Commercial |
$119.49
|
| Rate for Payer: Humana Commercial |
$106.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.69
|
| Rate for Payer: Ohio Health Group HMO |
$94.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.79
|
| Rate for Payer: PHCS Commercial |
$120.75
|
| Rate for Payer: United Healthcare All Payer |
$110.69
|
|
|
METHERGINE(METHYLERG .2MG/1TAB
|
Facility
|
OP
|
$125.78
|
|
|
Service Code
|
NDC 54063905
|
| Hospital Charge Code |
25000971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna Commercial |
$96.85
|
| Rate for Payer: Anthem Medicaid |
$43.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.11
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cigna Commercial |
$104.40
|
| Rate for Payer: First Health Commercial |
$119.49
|
| Rate for Payer: Humana Commercial |
$106.91
|
| Rate for Payer: Humana KY Medicaid |
$43.26
|
| Rate for Payer: Kentucky WC Medicaid |
$43.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.69
|
| Rate for Payer: Ohio Health Group HMO |
$94.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.79
|
| Rate for Payer: PHCS Commercial |
$120.75
|
| Rate for Payer: United Healthcare All Payer |
$110.69
|
|
|
METHERGINE(METHYLERGO .2MG/1ML
|
Facility
|
IP
|
$126.76
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
25002229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$121.69 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.87
|
| Rate for Payer: Cash Price |
$63.38
|
| Rate for Payer: Cigna Commercial |
$105.21
|
| Rate for Payer: First Health Commercial |
$120.42
|
| Rate for Payer: Humana Commercial |
$107.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.55
|
| Rate for Payer: Ohio Health Group HMO |
$95.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.46
|
| Rate for Payer: PHCS Commercial |
$121.69
|
| Rate for Payer: United Healthcare All Payer |
$111.55
|
|
|
METHERGINE(METHYLERGO .2MG/1ML
|
Facility
|
OP
|
$126.76
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
25002229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$121.69 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Anthem Medicaid |
$43.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.87
|
| Rate for Payer: Cash Price |
$63.38
|
| Rate for Payer: Cigna Commercial |
$105.21
|
| Rate for Payer: First Health Commercial |
$120.42
|
| Rate for Payer: Humana Commercial |
$107.75
|
| Rate for Payer: Humana KY Medicaid |
$43.59
|
| Rate for Payer: Kentucky WC Medicaid |
$44.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.55
|
| Rate for Payer: Ohio Health Group HMO |
$95.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.46
|
| Rate for Payer: PHCS Commercial |
$121.69
|
| Rate for Payer: United Healthcare All Payer |
$111.55
|
|
|
METHOTREXATE 2.5 MG 2.5MG/1TAB
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
25002540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$7.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.37
|
| Rate for Payer: Humana Commercial |
$8.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.68
|
| Rate for Payer: Ohio Health Group HMO |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.80
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
METHOTREXATE 2.5 MG 2.5MG/1TAB
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
25002540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$7.59
|
| Rate for Payer: Anthem Medicaid |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.37
|
| Rate for Payer: Humana Commercial |
$8.38
|
| Rate for Payer: Humana KY Medicaid |
$3.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.68
|
| Rate for Payer: Ohio Health Group HMO |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.80
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
METHOTREXATE 50MG (50MG SDV)
|
Facility
|
IP
|
$18.31
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
25002645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.28
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cigna Commercial |
$15.20
|
| Rate for Payer: First Health Commercial |
$17.39
|
| Rate for Payer: Humana Commercial |
$15.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.11
|
| Rate for Payer: Ohio Health Group HMO |
$13.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.63
|
| Rate for Payer: PHCS Commercial |
$17.58
|
| Rate for Payer: United Healthcare All Payer |
$16.11
|
|
|
METHOTREXATE 50MG (50MG SDV)
|
Facility
|
OP
|
$18.31
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
25002645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Anthem Medicaid |
$6.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.28
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cigna Commercial |
$15.20
|
| Rate for Payer: First Health Commercial |
$17.39
|
| Rate for Payer: Humana Commercial |
$15.56
|
| Rate for Payer: Humana KY Medicaid |
$6.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.11
|
| Rate for Payer: Ohio Health Group HMO |
$13.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.63
|
| Rate for Payer: PHCS Commercial |
$17.58
|
| Rate for Payer: United Healthcare All Payer |
$16.11
|
|
|
METHOTREXATE PF 250MG 10ML VL
|
Facility
|
OP
|
$183.07
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
25002647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna Commercial |
$140.96
|
| Rate for Payer: Anthem Medicaid |
$62.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.79
|
| Rate for Payer: Cash Price |
$91.53
|
| Rate for Payer: Cigna Commercial |
$151.95
|
| Rate for Payer: First Health Commercial |
$173.92
|
| Rate for Payer: Humana Commercial |
$155.61
|
| Rate for Payer: Humana KY Medicaid |
$62.96
|
| Rate for Payer: Kentucky WC Medicaid |
$63.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.10
|
| Rate for Payer: Ohio Health Group HMO |
$137.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.32
|
| Rate for Payer: PHCS Commercial |
$175.75
|
| Rate for Payer: United Healthcare All Payer |
$161.10
|
|
|
METHOTREXATE PF 250MG 10ML VL
|
Facility
|
IP
|
$183.07
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
25002647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna Commercial |
$140.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.79
|
| Rate for Payer: Cash Price |
$91.53
|
| Rate for Payer: Cigna Commercial |
$151.95
|
| Rate for Payer: First Health Commercial |
$173.92
|
| Rate for Payer: Humana Commercial |
$155.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.10
|
| Rate for Payer: Ohio Health Group HMO |
$137.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.32
|
| Rate for Payer: PHCS Commercial |
$175.75
|
| Rate for Payer: United Healthcare All Payer |
$161.10
|
|
|
METROGEL-VAGINAL(METRONID 70GM
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 45802013970
|
| Hospital Charge Code |
25000974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
METROGEL-VAGINAL(METRONID 70GM
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 45802013970
|
| Hospital Charge Code |
25000974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.55
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
METRONIDAZOLE 0.75% CRM 45G
|
Facility
|
OP
|
$6.81
|
|
|
Service Code
|
NDC 168032346
|
| Hospital Charge Code |
25000975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Anthem Medicaid |
$2.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.31
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cigna Commercial |
$5.65
|
| Rate for Payer: First Health Commercial |
$6.47
|
| Rate for Payer: Humana Commercial |
$5.79
|
| Rate for Payer: Humana KY Medicaid |
$2.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.99
|
| Rate for Payer: Ohio Health Group HMO |
$5.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.70
|
| Rate for Payer: PHCS Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Payer |
$5.99
|
|
|
METRONIDAZOLE 0.75% CRM 45G
|
Facility
|
IP
|
$6.81
|
|
|
Service Code
|
NDC 168032346
|
| Hospital Charge Code |
25000975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.31
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cigna Commercial |
$5.65
|
| Rate for Payer: First Health Commercial |
$6.47
|
| Rate for Payer: Humana Commercial |
$5.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.99
|
| Rate for Payer: Ohio Health Group HMO |
$5.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.70
|
| Rate for Payer: PHCS Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Payer |
$5.99
|
|
|
METRONIDAZOLE 10mg (500mg bag)
|
Facility
|
IP
|
$78.68
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
25003067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$60.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cigna Commercial |
$65.30
|
| Rate for Payer: First Health Commercial |
$74.75
|
| Rate for Payer: Humana Commercial |
$66.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
| Rate for Payer: Ohio Health Group HMO |
$59.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.29
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
METRONIDAZOLE 10mg (500mg bag)
|
Facility
|
OP
|
$78.68
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
25003067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$60.58
|
| Rate for Payer: Anthem Medicaid |
$27.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
| Rate for Payer: Cash Price |
$39.34
|
| Rate for Payer: Cigna Commercial |
$65.30
|
| Rate for Payer: First Health Commercial |
$74.75
|
| Rate for Payer: Humana Commercial |
$66.88
|
| Rate for Payer: Humana KY Medicaid |
$27.06
|
| Rate for Payer: Kentucky WC Medicaid |
$27.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
| Rate for Payer: Ohio Health Group HMO |
$59.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.29
|
| Rate for Payer: PHCS Commercial |
$75.53
|
| Rate for Payer: United Healthcare All Payer |
$69.24
|
|
|
METRONIDAZOLE 1% TOPGEL 60 GM
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
NDC 51672421503
|
| Hospital Charge Code |
25000976
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.45
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.07
|
| Rate for Payer: Humana Commercial |
$8.12
|
| Rate for Payer: Humana KY Medicaid |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$9.17
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
METRONIDAZOLE 1% TOPGEL 60 GM
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
NDC 51672421503
|
| Hospital Charge Code |
25000976
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.45
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.07
|
| Rate for Payer: Humana Commercial |
$8.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$9.17
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
MEVACOR 20MG 1TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 68084055901
|
| Hospital Charge Code |
25000977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
MEVACOR 20MG 1TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 68084055901
|
| Hospital Charge Code |
25000977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
MEXITIL (MEXILETINE 150MG/1CAP
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
25000978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.32
|
| Rate for Payer: Humana Commercial |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.14
|
| Rate for Payer: PHCS Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
MEXITIL (MEXILETINE 150MG/1CAP
|
Facility
|
OP
|
$4.55
|
|
|
Service Code
|
NDC 50742023901
|
| Hospital Charge Code |
25000978
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.32
|
| Rate for Payer: Humana Commercial |
$3.87
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.14
|
| Rate for Payer: PHCS Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
MEXITIL (MEXILETINE 200MG/1CAP
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
25000979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
MEXITIL (MEXILETINE 200MG/1CAP
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 50742024001
|
| Hospital Charge Code |
25000979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
MIACALCIN (CALCI/S 200IU/1SPRA
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
25000980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: Anthem Medicaid |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.06
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: First Health Commercial |
$9.81
|
| Rate for Payer: Humana Commercial |
$8.78
|
| Rate for Payer: Humana KY Medicaid |
$3.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.09
|
| Rate for Payer: Ohio Health Group HMO |
$7.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Payer |
$9.09
|
|
