|
NITROGLYCERIN 0.4 MG/ 10MG/1EA
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 378911293
|
| Hospital Charge Code |
25001088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
NITROGLYCERIN 0.4 MG/ 10MG/1EA
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 378911293
|
| Hospital Charge Code |
25001088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
NITROGLYCERIN 0.4MG 10ML SYR
|
Facility
|
IP
|
$60.35
|
|
| Hospital Charge Code |
25003281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.09
|
| Rate for Payer: First Health Commercial |
$57.33
|
| Rate for Payer: Humana Commercial |
$51.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.11
|
| Rate for Payer: Ohio Health Group HMO |
$45.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.64
|
| Rate for Payer: PHCS Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Payer |
$53.11
|
|
|
NITROGLYCERIN 0.4MG 10ML SYR
|
Facility
|
IP
|
$63.35
|
|
|
Service Code
|
NDC 517481001
|
| Hospital Charge Code |
25003281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$60.82 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.41
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cigna Commercial |
$52.58
|
| Rate for Payer: First Health Commercial |
$60.18
|
| Rate for Payer: Humana Commercial |
$53.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.75
|
| Rate for Payer: Ohio Health Group HMO |
$47.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.71
|
| Rate for Payer: PHCS Commercial |
$60.82
|
| Rate for Payer: United Healthcare All Payer |
$55.75
|
|
|
NITROGLYCERIN 0.4MG 10ML SYR
|
Facility
|
OP
|
$60.35
|
|
| Hospital Charge Code |
25003281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Anthem Medicaid |
$20.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.09
|
| Rate for Payer: First Health Commercial |
$57.33
|
| Rate for Payer: Humana Commercial |
$51.30
|
| Rate for Payer: Humana KY Medicaid |
$20.75
|
| Rate for Payer: Kentucky WC Medicaid |
$20.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.11
|
| Rate for Payer: Ohio Health Group HMO |
$45.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.64
|
| Rate for Payer: PHCS Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Payer |
$53.11
|
|
|
NITROGLYCERIN 0.4MG 10ML SYR
|
Facility
|
OP
|
$63.35
|
|
|
Service Code
|
NDC 517481001
|
| Hospital Charge Code |
25003281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$60.82 |
| Rate for Payer: Aetna Commercial |
$48.78
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.41
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cigna Commercial |
$52.58
|
| Rate for Payer: First Health Commercial |
$60.18
|
| Rate for Payer: Humana Commercial |
$53.85
|
| Rate for Payer: Humana KY Medicaid |
$21.79
|
| Rate for Payer: Kentucky WC Medicaid |
$22.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.75
|
| Rate for Payer: Ohio Health Group HMO |
$47.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.71
|
| Rate for Payer: PHCS Commercial |
$60.82
|
| Rate for Payer: United Healthcare All Payer |
$55.75
|
|
|
NITROGLYCERIN 0.4 MG SL T (3/B
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| 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 |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NITROGLYCERIN 0.4 MG SL T (3/B
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| 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 |
$3.53
|
| 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 |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NITROGLYCERIN 50MG/10ML
|
Facility
|
IP
|
$122.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003277
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$36.77 |
| 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 |
$36.77
|
| 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 |
$98.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.56
|
| Rate for Payer: PHCS Commercial |
$117.65
|
| Rate for Payer: United Healthcare All Payer |
$107.84
|
|
|
NITROGLYCERIN 50MG/10ML
|
Facility
|
OP
|
$122.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003277
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$36.77 |
| 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 |
$36.77
|
| 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 |
$98.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.56
|
| Rate for Payer: PHCS Commercial |
$117.65
|
| Rate for Payer: United Healthcare All Payer |
$107.84
|
|
|
NITROGLYCERIN 5mg (50mg gtt)
|
Facility
|
IP
|
$129.54
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
25003282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.86 |
| 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 |
$103.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.38
|
| Rate for Payer: PHCS Commercial |
$124.36
|
| Rate for Payer: United Healthcare All Payer |
$114.00
|
|
|
NITROGLYCERIN 5mg (50mg gtt)
|
Facility
|
OP
|
$129.54
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
25003282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Anthem Medicaid |
$44.55
|
| 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: Humana KY Medicaid |
$44.55
|
| 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 |
$38.86
|
| 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 |
$103.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.38
|
| Rate for Payer: PHCS Commercial |
$124.36
|
| Rate for Payer: United Healthcare All Payer |
$114.00
|
|
|
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 |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
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 |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
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 |
$1.43 |
| 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 |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.29
|
| 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 |
$1.43 |
| 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 |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.29
|
| 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 |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| 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 |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| 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 |
$3.13 |
| Max. Negotiated Rate |
$10.00 |
| 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
|
| 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 |
$8.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.19
|
| Rate for Payer: PHCS Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Payer |
$9.17
|
|
|
NITROGLYCERIN UD 1 GRAM
|
Facility
|
OP
|
$10.42
|
|
|
Service Code
|
NDC 281032608
|
| Hospital Charge Code |
25003289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| 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 |
$8.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.19
|
| Rate for Payer: PHCS Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Payer |
$9.17
|
|
|
NITROGLY SYR 100MCG/ML(20ML)
|
Facility
|
OP
|
$77.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003287
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.13 |
| 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 |
$61.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.21
|
| Rate for Payer: PHCS Commercial |
$74.03
|
| Rate for Payer: United Healthcare All Payer |
$67.86
|
|
|
NITROGLY SYR 100MCG/ML(20ML)
|
Facility
|
IP
|
$77.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003287
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.13 |
| 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 |
$61.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.21
|
| Rate for Payer: PHCS Commercial |
$74.03
|
| Rate for Payer: United Healthcare All Payer |
$67.86
|
|
|
NITROLINGUAL (NITROGLY 200DOSE
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
25003290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| 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 |
$8.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.96
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
|
NITROLINGUAL (NITROGLY 200DOSE
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 45802021001
|
| Hospital Charge Code |
25003290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| 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 |
$8.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.96
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
|
NITROSTAT (NITROGLYCERI 100TAB
|
Facility
|
IP
|
$3.09
|
|
|
Service Code
|
NDC 58151030901
|
| Hospital Charge Code |
25003291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| 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 |
$2.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.13
|
| Rate for Payer: PHCS Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Payer |
$2.72
|
|
