|
NITROGLYCERIN 50MG/10ML
|
Facility
|
OP
|
$122.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003277
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$94.36
|
| Rate for Payer: Anthem Medicaid |
$42.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.59
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cigna Commercial |
$101.72
|
| Rate for Payer: First Health Commercial |
$116.42
|
| Rate for Payer: Humana Commercial |
$104.17
|
| Rate for Payer: Humana KY Medicaid |
$42.14
|
| Rate for Payer: Kentucky WC Medicaid |
$42.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.84
|
| Rate for Payer: Ohio Health Group HMO |
$91.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.99
|
| Rate for Payer: PHCS Commercial |
$117.65
|
| Rate for Payer: United Healthcare All Payer |
$107.84
|
|
|
NITROGLYCERIN 50MG/10ML
|
Facility
|
IP
|
$122.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003277
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$94.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.59
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cigna Commercial |
$101.72
|
| Rate for Payer: First Health Commercial |
$116.42
|
| Rate for Payer: Humana Commercial |
$104.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.84
|
| Rate for Payer: Ohio Health Group HMO |
$91.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.99
|
| Rate for Payer: PHCS Commercial |
$117.65
|
| Rate for Payer: United Healthcare All Payer |
$107.84
|
|
|
NITROGLYCERIN 5mg (50mg gtt)
|
Facility
|
OP
|
$129.54
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
25003282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Anthem Medicaid |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.74
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Cigna Commercial |
$107.52
|
| Rate for Payer: First Health Commercial |
$123.06
|
| Rate for Payer: Humana Commercial |
$110.11
|
| Rate for Payer: Humana KY Medicaid |
$44.55
|
| Rate for Payer: Humana Medicare Advantage |
$1.29
|
| Rate for Payer: Kentucky WC Medicaid |
$45.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.00
|
| Rate for Payer: Ohio Health Group HMO |
$97.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.16
|
| Rate for Payer: PHCS Commercial |
$124.36
|
| Rate for Payer: United Healthcare All Payer |
$114.00
|
|
|
NITROGLYCERIN 5mg (50mg gtt)
|
Facility
|
IP
|
$129.54
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
25003282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.04
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Cigna Commercial |
$107.52
|
| Rate for Payer: First Health Commercial |
$123.06
|
| Rate for Payer: Humana Commercial |
$110.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.00
|
| Rate for Payer: Ohio Health Group HMO |
$97.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.16
|
| Rate for Payer: PHCS Commercial |
$124.36
|
| Rate for Payer: United Healthcare All Payer |
$114.00
|
|
|
NITROGLYCERIN SR 2. 2.5MG/1CAP
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 49483022110
|
| Hospital Charge Code |
25003284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| 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 |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
NITROGLYCERIN SR 2. 2.5MG/1CAP
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 49483022110
|
| Hospital Charge Code |
25003284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| 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 |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
NITROGLYCERIN SR 6. 6.5MG/1CAP
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
NDC 49483022210
|
| Hospital Charge Code |
25003285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: First Health Commercial |
$4.53
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.58
|
| Rate for Payer: United Healthcare All Payer |
$4.20
|
|
|
NITROGLYCERIN SR 6. 6.5MG/1CAP
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
NDC 49483022210
|
| Hospital Charge Code |
25003285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: First Health Commercial |
$4.53
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.58
|
| Rate for Payer: United Healthcare All Payer |
$4.20
|
|
|
NITROGLYCERIN SR 9 MG 9MG/1CAP
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 49483022310
|
| Hospital Charge Code |
25003286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
NITROGLYCERIN SR 9 MG 9MG/1CAP
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 49483022310
|
| Hospital Charge Code |
25003286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
NITROGLYCERIN UD 1 GRAM
|
Facility
|
IP
|
$10.42
|
|
|
Service Code
|
NDC 281032608
|
| Hospital Charge Code |
25003289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Humana Commercial |
$8.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.17
|
| Rate for Payer: Ohio Health Group HMO |
$7.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Payer |
$9.17
|
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.13
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cigna Commercial |
$8.65
|
| Rate for Payer: First Health Commercial |
$9.90
|
|
|
NITROGLYCERIN UD 1 GRAM
|
Facility
|
OP
|
$10.42
|
|
|
Service Code
|
NDC 281032608
|
| Hospital Charge Code |
25003289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Anthem Medicaid |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.13
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cigna Commercial |
$8.65
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: Humana Commercial |
$8.86
|
| Rate for Payer: Humana KY Medicaid |
$3.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.17
|
| Rate for Payer: Ohio Health Group HMO |
$7.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Payer |
$9.17
|
|
|
NITROGLY SYR 100MCG/ML(20ML)
|
Facility
|
IP
|
$77.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$59.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.15
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: First Health Commercial |
$73.25
|
| Rate for Payer: Humana Commercial |
$65.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.86
|
| Rate for Payer: Ohio Health Group HMO |
$57.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.90
|
| Rate for Payer: PHCS Commercial |
$74.03
|
| Rate for Payer: United Healthcare All Payer |
$67.86
|
|
|
NITROGLY SYR 100MCG/ML(20ML)
|
Facility
|
OP
|
$77.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$59.37
|
| Rate for Payer: Anthem Medicaid |
$26.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.15
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: First Health Commercial |
$73.25
|
| Rate for Payer: Humana Commercial |
$65.54
|
| Rate for Payer: Humana KY Medicaid |
$26.52
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.86
|
| Rate for Payer: Ohio Health Group HMO |
$57.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.90
|
| Rate for Payer: PHCS Commercial |
$74.03
|
| Rate for Payer: United Healthcare All Payer |
$67.86
|
|
|
NITROLINGUAL (NITROGLY 200DOSE
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
25003290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Anthem Medicaid |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: First Health Commercial |
$9.58
|
| Rate for Payer: Humana Commercial |
$8.57
|
| Rate for Payer: Humana KY Medicaid |
$3.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.87
|
| Rate for Payer: Ohio Health Group HMO |
$7.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
|
NITROLINGUAL (NITROGLY 200DOSE
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
25003290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: First Health Commercial |
$9.58
|
| Rate for Payer: Humana Commercial |
$8.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.87
|
| Rate for Payer: Ohio Health Group HMO |
$7.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
|
NITROSTAT (NITROGLYCERI 100TAB
|
Facility
|
OP
|
$3.09
|
|
|
Service Code
|
NDC 58151030901
|
| Hospital Charge Code |
25003291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Anthem Medicaid |
$1.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.41
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna Commercial |
$2.56
|
| Rate for Payer: First Health Commercial |
$2.94
|
| Rate for Payer: Humana Commercial |
$2.63
|
| Rate for Payer: Humana KY Medicaid |
$1.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.72
|
| Rate for Payer: Ohio Health Group HMO |
$2.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Payer |
$2.72
|
|
|
NITROSTAT (NITROGLYCERI 100TAB
|
Facility
|
IP
|
$3.09
|
|
|
Service Code
|
NDC 58151030901
|
| Hospital Charge Code |
25003291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.41
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna Commercial |
$2.56
|
| Rate for Payer: First Health Commercial |
$2.94
|
| Rate for Payer: Humana Commercial |
$2.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.72
|
| Rate for Payer: Ohio Health Group HMO |
$2.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Payer |
$2.72
|
|
|
NIVESTYM 300MCG/0.5ML SYRINGE
|
Facility
|
IP
|
$1,193.55
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
25002734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.16 |
| Max. Negotiated Rate |
$1,145.81 |
| Rate for Payer: Aetna Commercial |
$919.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$930.97
|
| Rate for Payer: Cash Price |
$596.78
|
| Rate for Payer: Cigna Commercial |
$990.65
|
| Rate for Payer: First Health Commercial |
$1,133.87
|
| Rate for Payer: Humana Commercial |
$1,014.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$978.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$880.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.32
|
| Rate for Payer: Ohio Health Group HMO |
$895.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.00
|
| Rate for Payer: PHCS Commercial |
$1,145.81
|
| Rate for Payer: United Healthcare All Payer |
$1,050.32
|
|
|
NIVESTYM 300MCG/0.5ML SYRINGE
|
Facility
|
OP
|
$1,193.55
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
25002734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1,145.81 |
| Rate for Payer: Aetna Commercial |
$919.03
|
| Rate for Payer: Anthem Medicaid |
$410.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$930.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.39
|
| Rate for Payer: Cash Price |
$596.78
|
| Rate for Payer: Cash Price |
$596.78
|
| Rate for Payer: Cigna Commercial |
$990.65
|
| Rate for Payer: First Health Commercial |
$1,133.87
|
| Rate for Payer: Humana Commercial |
$1,014.52
|
| Rate for Payer: Humana KY Medicaid |
$410.46
|
| Rate for Payer: Humana Medicare Advantage |
$0.29
|
| Rate for Payer: Kentucky WC Medicaid |
$414.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$978.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$880.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,050.32
|
| Rate for Payer: Ohio Health Group HMO |
$895.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.00
|
| Rate for Payer: PHCS Commercial |
$1,145.81
|
| Rate for Payer: United Healthcare All Payer |
$1,050.32
|
|
|
NIVESTYM 480MCG/0.8ML SYRINGE
|
Facility
|
IP
|
$1,909.68
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
25002735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.26 |
| Max. Negotiated Rate |
$1,833.29 |
| Rate for Payer: Aetna Commercial |
$1,470.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.55
|
| Rate for Payer: Cash Price |
$954.84
|
| Rate for Payer: Cigna Commercial |
$1,585.03
|
| Rate for Payer: First Health Commercial |
$1,814.20
|
| Rate for Payer: Humana Commercial |
$1,623.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,565.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.00
|
| Rate for Payer: PHCS Commercial |
$1,833.29
|
| Rate for Payer: United Healthcare All Payer |
$1,680.52
|
|
|
NIVESTYM 480MCG/0.8ML SYRINGE
|
Facility
|
OP
|
$1,909.68
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
25002735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1,833.29 |
| Rate for Payer: Aetna Commercial |
$1,470.45
|
| Rate for Payer: Anthem Medicaid |
$656.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.39
|
| Rate for Payer: Cash Price |
$954.84
|
| Rate for Payer: Cash Price |
$954.84
|
| Rate for Payer: Cigna Commercial |
$1,585.03
|
| Rate for Payer: First Health Commercial |
$1,814.20
|
| Rate for Payer: Humana Commercial |
$1,623.23
|
| Rate for Payer: Humana KY Medicaid |
$656.74
|
| Rate for Payer: Humana Medicare Advantage |
$0.29
|
| Rate for Payer: Kentucky WC Medicaid |
$663.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,565.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.00
|
| Rate for Payer: PHCS Commercial |
$1,833.29
|
| Rate for Payer: United Healthcare All Payer |
$1,680.52
|
|
|
NIVOLUMAB 100MG/10ML
|
Facility
|
IP
|
$17,336.94
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,253.80 |
| Max. Negotiated Rate |
$16,643.46 |
| Rate for Payer: Aetna Commercial |
$13,349.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,522.81
|
| Rate for Payer: Cash Price |
$8,668.47
|
| Rate for Payer: Cigna Commercial |
$14,389.66
|
| Rate for Payer: First Health Commercial |
$16,470.09
|
| Rate for Payer: Humana Commercial |
$14,736.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,216.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,794.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,201.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,256.51
|
| Rate for Payer: Ohio Health Group HMO |
$13,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,467.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,374.45
|
| Rate for Payer: PHCS Commercial |
$16,643.46
|
| Rate for Payer: United Healthcare All Payer |
$15,256.51
|
|
|
NIVOLUMAB 100MG/10ML
|
Facility
|
OP
|
$17,336.94
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$16,643.46 |
| Rate for Payer: Aetna Commercial |
$13,349.44
|
| Rate for Payer: Anthem Medicaid |
$5,962.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,522.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.97
|
| Rate for Payer: Cash Price |
$8,668.47
|
| Rate for Payer: Cash Price |
$8,668.47
|
| Rate for Payer: Cigna Commercial |
$14,389.66
|
| Rate for Payer: First Health Commercial |
$16,470.09
|
| Rate for Payer: Humana Commercial |
$14,736.40
|
| Rate for Payer: Humana KY Medicaid |
$5,962.17
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Kentucky WC Medicaid |
$6,022.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,216.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,794.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,081.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,256.51
|
| Rate for Payer: Ohio Health Group HMO |
$13,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,467.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,374.45
|
| Rate for Payer: PHCS Commercial |
$16,643.46
|
| Rate for Payer: United Healthcare All Payer |
$15,256.51
|
|
|
NIX COMP LICE TX KIT COMBO PKG
|
Facility
|
OP
|
$34.94
|
|
|
Service Code
|
NDC 63736024797
|
| Hospital Charge Code |
25001090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$26.90
|
| Rate for Payer: Anthem Medicaid |
$12.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.25
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cigna Commercial |
$29.00
|
| Rate for Payer: First Health Commercial |
$33.19
|
| Rate for Payer: Humana Commercial |
$29.70
|
| Rate for Payer: Humana KY Medicaid |
$12.02
|
| Rate for Payer: Kentucky WC Medicaid |
$12.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.75
|
| Rate for Payer: Ohio Health Group HMO |
$26.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.83
|
| Rate for Payer: PHCS Commercial |
$33.54
|
| Rate for Payer: United Healthcare All Payer |
$30.75
|
|
