|
NEXPLANON 68 MG IMPL
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
25002486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
NEXTERONE[30 MG]150MG/100MLSOL
|
Facility
|
IP
|
$190.69
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$183.06 |
| Rate for Payer: Aetna Commercial |
$146.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.74
|
| Rate for Payer: Cash Price |
$95.34
|
| Rate for Payer: Cigna Commercial |
$158.27
|
| Rate for Payer: First Health Commercial |
$181.16
|
| Rate for Payer: Humana Commercial |
$162.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.81
|
| Rate for Payer: Ohio Health Group HMO |
$143.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.58
|
| Rate for Payer: PHCS Commercial |
$183.06
|
| Rate for Payer: United Healthcare All Payer |
$167.81
|
|
|
NEXTERONE[30 MG]150MG/100MLSOL
|
Facility
|
OP
|
$190.69
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$183.06 |
| Rate for Payer: Aetna Commercial |
$146.83
|
| Rate for Payer: Anthem Medicaid |
$65.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.74
|
| Rate for Payer: Cash Price |
$95.34
|
| Rate for Payer: Cigna Commercial |
$158.27
|
| Rate for Payer: First Health Commercial |
$181.16
|
| Rate for Payer: Humana Commercial |
$162.09
|
| Rate for Payer: Humana KY Medicaid |
$65.58
|
| Rate for Payer: Kentucky WC Medicaid |
$66.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.81
|
| Rate for Payer: Ohio Health Group HMO |
$143.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.58
|
| Rate for Payer: PHCS Commercial |
$183.06
|
| Rate for Payer: United Healthcare All Payer |
$167.81
|
|
|
NEXTERONE 30MG [360MG/200ML]
|
Facility
|
OP
|
$202.14
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$194.05 |
| Rate for Payer: Aetna Commercial |
$155.65
|
| Rate for Payer: Anthem Medicaid |
$69.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.67
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cigna Commercial |
$167.78
|
| Rate for Payer: First Health Commercial |
$192.03
|
| Rate for Payer: Humana Commercial |
$171.82
|
| Rate for Payer: Humana KY Medicaid |
$69.52
|
| Rate for Payer: Kentucky WC Medicaid |
$70.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.88
|
| Rate for Payer: Ohio Health Group HMO |
$151.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.48
|
| Rate for Payer: PHCS Commercial |
$194.05
|
| Rate for Payer: United Healthcare All Payer |
$177.88
|
|
|
NEXTERONE 30MG [360MG/200ML]
|
Facility
|
IP
|
$202.14
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$194.05 |
| Rate for Payer: Aetna Commercial |
$155.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.67
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cigna Commercial |
$167.78
|
| Rate for Payer: First Health Commercial |
$192.03
|
| Rate for Payer: Humana Commercial |
$171.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.88
|
| Rate for Payer: Ohio Health Group HMO |
$151.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.48
|
| Rate for Payer: PHCS Commercial |
$194.05
|
| Rate for Payer: United Healthcare All Payer |
$177.88
|
|
|
NFCT AGENT DETECTION GI
|
Facility
|
OP
|
$139.62
|
|
|
Service Code
|
HCPCS 87505
|
| Hospital Charge Code |
30002063
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.34 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna Commercial |
$107.51
|
| Rate for Payer: Anthem Medicaid |
$128.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$128.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$179.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.29
|
| Rate for Payer: Cash Price |
$69.81
|
| Rate for Payer: Cash Price |
$69.81
|
| Rate for Payer: Cigna Commercial |
$115.88
|
| Rate for Payer: First Health Commercial |
$132.64
|
| Rate for Payer: Humana Commercial |
$118.68
|
| Rate for Payer: Humana KY Medicaid |
$128.29
|
| Rate for Payer: Humana Medicare Advantage |
$128.29
|
| Rate for Payer: Kentucky WC Medicaid |
$129.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.87
|
| Rate for Payer: Ohio Health Group HMO |
$104.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.34
|
| Rate for Payer: PHCS Commercial |
$134.04
|
| Rate for Payer: United Healthcare All Payer |
$122.87
|
|
|
NFCT AGENT DETECTION GI
|
Facility
|
IP
|
$139.62
|
|
|
Service Code
|
HCPCS 87505
|
| Hospital Charge Code |
30002063
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$134.04 |
| Rate for Payer: Aetna Commercial |
$107.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.11
|
| Rate for Payer: Cash Price |
$69.81
|
| Rate for Payer: Cigna Commercial |
$115.88
|
| Rate for Payer: First Health Commercial |
$132.64
|
| Rate for Payer: Humana Commercial |
$118.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.87
|
| Rate for Payer: Ohio Health Group HMO |
$104.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.34
|
| Rate for Payer: PHCS Commercial |
$134.04
|
| Rate for Payer: United Healthcare All Payer |
$122.87
|
|
|
NFCT AGT HIV GNRJ SEQ ALYS
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
HCPCS 0219U
|
| Hospital Charge Code |
30002026
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$585.81 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem Medicaid |
$725.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$725.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,015.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$725.00
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| 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 |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.81
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
NFCT AGT HIV GNRJ SEQ ALYS
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
HCPCS 0219U
|
| Hospital Charge Code |
30002026
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$815.04 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.75
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.81
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
NIACIN(NICOTINIC ACI 50MG/1TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 54629005101
|
| Hospital Charge Code |
25001075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
NIACIN(NICOTINIC ACI 50MG/1TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 54629005101
|
| Hospital Charge Code |
25001075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| 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 |
$1.47 |
| 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 |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| 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 |
$1.47 |
| 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 |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
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 |
$1.44 |
| 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 |
$3.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.32
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
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 |
$1.44 |
| 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 |
$3.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.32
|
| 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 |
$1.29 |
| 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 |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| 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 |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| 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
|
| 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 |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NICODERM(NICOTINE TRA 14MG/1EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
25001079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| 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 |
$7.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.75
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
NICODERM(NICOTINE TRA 14MG/1EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
NDC 43598044774
|
| Hospital Charge Code |
25001079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| 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 |
$7.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.75
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
NICODERM(NICOTINE TRA 21MG/1EA
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
NDC 46122035374
|
| Hospital Charge Code |
25001080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| 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 |
$7.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.73
|
| Rate for Payer: PHCS Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Payer |
$8.59
|
|
|
NICODERM(NICOTINE TRA 21MG/1EA
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
NDC 46122035374
|
| Hospital Charge Code |
25001080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| 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 |
$7.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.73
|
| 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 |
$2.91 |
| 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 |
$7.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.70
|
| 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 |
$2.91 |
| 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 |
$7.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.70
|
| Rate for Payer: PHCS Commercial |
$9.32
|
| Rate for Payer: United Healthcare All Payer |
$8.54
|
|
|
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 |
$1.40 |
| 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 |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
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 |
$1.40 |
| 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 |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
