|
NFCT AGT HIV GNRJ SEQ ALYS
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
HCPCS 0219U
|
| Hospital Charge Code |
30002026
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem Medicaid |
$725.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$725.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,015.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$725.00
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Humana KY Medicaid |
$725.00
|
| Rate for Payer: Humana Medicare Advantage |
$725.00
|
| Rate for Payer: Kentucky WC Medicaid |
$732.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.37
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
NIACIN(NICOTINIC ACI 50MG/1TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 54629005101
|
| Hospital Charge Code |
25001075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
NIACIN(NICOTINIC ACI 50MG/1TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 54629005101
|
| Hospital Charge Code |
25001075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
NIASPAN ER(NIACIN)500 MG TAB
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 62175032046
|
| Hospital Charge Code |
25001076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
NIASPAN ER(NIACIN)500 MG TAB
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 62175032046
|
| Hospital Charge Code |
25001076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
NIASPAN(NIACIN)750 MG ER TAB
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
NDC 47335061481
|
| Hospital Charge Code |
25001077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
NIASPAN(NIACIN)750 MG ER TAB
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
NDC 47335061481
|
| Hospital Charge Code |
25001077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
NICOBID (NIACIN) 25 250MG/1CAP
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 10006070020
|
| Hospital Charge Code |
25001078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NICOBID (NIACIN) 25 250MG/1CAP
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 10006070020
|
| Hospital Charge Code |
25001078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
|
|
NICODERM(NICOTINE TRA 14MG/1EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
25001079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.63
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cigna Commercial |
$8.12
|
| Rate for Payer: First Health Commercial |
$9.29
|
| Rate for Payer: Humana Commercial |
$8.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.61
|
| Rate for Payer: Ohio Health Group HMO |
$7.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
NICODERM(NICOTINE TRA 14MG/1EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
25001079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Anthem Medicaid |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.63
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cigna Commercial |
$8.12
|
| Rate for Payer: First Health Commercial |
$9.29
|
| Rate for Payer: Humana Commercial |
$8.31
|
| Rate for Payer: Humana KY Medicaid |
$3.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.61
|
| Rate for Payer: Ohio Health Group HMO |
$7.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
NICODERM(NICOTINE TRA 21MG/1EA
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
NDC 46122035374
|
| Hospital Charge Code |
25001080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Anthem Medicaid |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.61
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna Commercial |
$8.10
|
| Rate for Payer: First Health Commercial |
$9.27
|
| Rate for Payer: Humana Commercial |
$8.30
|
| Rate for Payer: Humana KY Medicaid |
$3.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.59
|
| Rate for Payer: Ohio Health Group HMO |
$7.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Payer |
$8.59
|
|
|
NICODERM(NICOTINE TRA 21MG/1EA
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
NDC 46122035374
|
| Hospital Charge Code |
25001080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.61
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cigna Commercial |
$8.10
|
| Rate for Payer: First Health Commercial |
$9.27
|
| Rate for Payer: Humana Commercial |
$8.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.59
|
| Rate for Payer: Ohio Health Group HMO |
$7.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Payer |
$8.59
|
|
|
NICODERM(NICOTINE TRAN 7MG/1EA
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
NDC 536589488
|
| Hospital Charge Code |
25001081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Anthem Medicaid |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna Commercial |
$8.06
|
| Rate for Payer: First Health Commercial |
$9.22
|
| Rate for Payer: Humana Commercial |
$8.25
|
| Rate for Payer: Humana KY Medicaid |
$3.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.54
|
| Rate for Payer: Ohio Health Group HMO |
$7.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$9.32
|
| Rate for Payer: United Healthcare All Payer |
$8.54
|
|
|
NICODERM(NICOTINE TRAN 7MG/1EA
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
NDC 536589488
|
| Hospital Charge Code |
25001081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna Commercial |
$8.06
|
| Rate for Payer: First Health Commercial |
$9.22
|
| Rate for Payer: Humana Commercial |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.54
|
| Rate for Payer: Ohio Health Group HMO |
$7.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$9.32
|
| Rate for Payer: United Healthcare All Payer |
$8.54
|
|
|
NICOTINE 2 MG GUM (PER GUM)
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 536302934
|
| Hospital Charge Code |
25001082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
NICOTINE 2 MG GUM (PER GUM)
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 536302934
|
| Hospital Charge Code |
25001082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
NIFEREX-150 (IRON) 150MG/1CAP
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 904539561
|
| Hospital Charge Code |
25001084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| 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 |
$0.87
|
| 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 |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
NIFEREX-150 (IRON) 150MG/1CAP
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 904539561
|
| Hospital Charge Code |
25001084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| 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 |
$0.87
|
| 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 |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
NIMBEX(CISTRACURIUM) 20MG/10ML
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
NDC 781315295
|
| Hospital Charge Code |
25003271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
NIMBEX(CISTRACURIUM) 20MG/10ML
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
NDC 781315295
|
| Hospital Charge Code |
25003271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
NIMOTOP (NIMODIPINE) 30MG/1CAP
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 57664013564
|
| Hospital Charge Code |
25001085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
NIMOTOP (NIMODIPINE) 30MG/1CAP
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 57664013564
|
| Hospital Charge Code |
25001085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
NIPENT (PENTOSTATIN) 10 MG VL
|
Facility
|
IP
|
$16,084.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
25002656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,090.98 |
| Max. Negotiated Rate |
$15,441.10 |
| Rate for Payer: Aetna Commercial |
$12,385.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,545.89
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cigna Commercial |
$13,350.12
|
| Rate for Payer: First Health Commercial |
$15,280.26
|
| Rate for Payer: Humana Commercial |
$13,671.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,189.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,870.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,825.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,154.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,063.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,986.19
|
| Rate for Payer: PHCS Commercial |
$15,441.10
|
| Rate for Payer: United Healthcare All Payer |
$14,154.34
|
|
|
NIPENT (PENTOSTATIN) 10 MG VL
|
Facility
|
OP
|
$16,084.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
25002656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,090.98 |
| Max. Negotiated Rate |
$15,441.10 |
| Rate for Payer: Aetna Commercial |
$12,385.05
|
| Rate for Payer: Anthem Medicaid |
$5,531.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,273.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,545.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,182.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,068.76
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cigna Commercial |
$13,350.12
|
| Rate for Payer: First Health Commercial |
$15,280.26
|
| Rate for Payer: Humana Commercial |
$13,671.81
|
| Rate for Payer: Humana KY Medicaid |
$5,531.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,273.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,587.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,189.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,870.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,642.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,154.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,063.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,986.19
|
| Rate for Payer: PHCS Commercial |
$15,441.10
|
| Rate for Payer: United Healthcare All Payer |
$14,154.34
|
|
