|
NORPACE (DISOPYRAMI 100MG/1CAP
|
Facility
|
OP
|
$9.99
|
|
|
Service Code
|
NDC 93312701
|
| Hospital Charge Code |
25001100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.79
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.29
|
| Rate for Payer: First Health Commercial |
$9.49
|
| Rate for Payer: Humana Commercial |
$8.49
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.79
|
| Rate for Payer: Ohio Health Group HMO |
$7.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.89
|
| Rate for Payer: PHCS Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Payer |
$8.79
|
|
|
NORPACE (DISOPYRAMI 150MG/1CAP
|
Facility
|
IP
|
$10.25
|
|
|
Service Code
|
NDC 93312901
|
| Hospital Charge Code |
25001101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.51
|
| Rate for Payer: First Health Commercial |
$9.74
|
| Rate for Payer: Humana Commercial |
$8.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.02
|
| Rate for Payer: Ohio Health Group HMO |
$7.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.07
|
| Rate for Payer: PHCS Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Payer |
$9.02
|
|
|
NORPACE (DISOPYRAMI 150MG/1CAP
|
Facility
|
OP
|
$10.25
|
|
|
Service Code
|
NDC 93312901
|
| Hospital Charge Code |
25001101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.51
|
| Rate for Payer: First Health Commercial |
$9.74
|
| Rate for Payer: Humana Commercial |
$8.71
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.02
|
| Rate for Payer: Ohio Health Group HMO |
$7.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.07
|
| Rate for Payer: PHCS Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Payer |
$9.02
|
|
|
NORVASC AMLODIPINE 2.5MG TAB
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 29300039619
|
| Hospital Charge Code |
25001105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
NORVASC AMLODIPINE 2.5MG TAB
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 29300039619
|
| Hospital Charge Code |
25001105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
NORVASC (AMLODIPINE) 5MG/1TAB
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 60687048801
|
| Hospital Charge Code |
25001104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
NORVASC (AMLODIPINE) 5MG/1TAB
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 60687048801
|
| Hospital Charge Code |
25001104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
NORVASC(AMLODIPINE BESYL)10MGT
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 904637161
|
| Hospital Charge Code |
25001106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
NORVASC(AMLODIPINE BESYL)10MGT
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 904637161
|
| Hospital Charge Code |
25001106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
NORVIR 100MG CAPSULE
|
Facility
|
IP
|
$10.67
|
|
|
Service Code
|
NDC 31722059730
|
| Hospital Charge Code |
25001107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.32
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: First Health Commercial |
$10.14
|
| Rate for Payer: Humana Commercial |
$9.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.39
|
| Rate for Payer: Ohio Health Group HMO |
$8.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.36
|
| Rate for Payer: PHCS Commercial |
$10.24
|
| Rate for Payer: United Healthcare All Payer |
$9.39
|
|
|
NORVIR 100MG CAPSULE
|
Facility
|
OP
|
$10.67
|
|
|
Service Code
|
NDC 31722059730
|
| Hospital Charge Code |
25001107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.32
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: First Health Commercial |
$10.14
|
| Rate for Payer: Humana Commercial |
$9.07
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.39
|
| Rate for Payer: Ohio Health Group HMO |
$8.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.36
|
| Rate for Payer: PHCS Commercial |
$10.24
|
| Rate for Payer: United Healthcare All Payer |
$9.39
|
|
|
NOVO7 (FCTR VIIA) 1MCG 5000V
|
Facility
|
IP
|
$78.81
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
25002476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Aetna Commercial |
$60.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.47
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cigna Commercial |
$65.41
|
| Rate for Payer: First Health Commercial |
$74.87
|
| Rate for Payer: Humana Commercial |
$66.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.35
|
| Rate for Payer: Ohio Health Group HMO |
$59.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.38
|
| Rate for Payer: PHCS Commercial |
$75.66
|
| Rate for Payer: United Healthcare All Payer |
$69.35
|
|
|
NOVO7 (FCTR VIIA) 1MCG 5000V
|
Facility
|
OP
|
$78.81
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
25002476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Aetna Commercial |
$60.68
|
| Rate for Payer: Anthem Medicaid |
$27.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.58
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cigna Commercial |
$65.41
|
| Rate for Payer: First Health Commercial |
$74.87
|
| Rate for Payer: Humana Commercial |
$66.99
|
| Rate for Payer: Humana KY Medicaid |
$27.10
|
| Rate for Payer: Humana Medicare Advantage |
$2.65
|
| Rate for Payer: Kentucky WC Medicaid |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.35
|
| Rate for Payer: Ohio Health Group HMO |
$59.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.38
|
| Rate for Payer: PHCS Commercial |
$75.66
|
| Rate for Payer: United Healthcare All Payer |
$69.35
|
|
|
NOVOLOG 5 UN [100UN/ML 10ML V
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002191
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.28 |
| Max. Negotiated Rate |
$378.48 |
| Rate for Payer: Aetna Commercial |
$303.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.51
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: First Health Commercial |
$374.54
|
| Rate for Payer: Humana Commercial |
$335.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.94
|
| Rate for Payer: Ohio Health Group HMO |
$295.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.03
|
| Rate for Payer: PHCS Commercial |
$378.48
|
| Rate for Payer: United Healthcare All Payer |
$346.94
|
|
|
NOVOLOG 5 UN [100UN/ML 10ML V
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002191
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.28 |
| Max. Negotiated Rate |
$378.48 |
| Rate for Payer: Aetna Commercial |
$303.57
|
| Rate for Payer: Anthem Medicaid |
$135.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.51
|
| Rate for Payer: Cash Price |
$197.12
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: First Health Commercial |
$374.54
|
| Rate for Payer: Humana Commercial |
$335.11
|
| Rate for Payer: Humana KY Medicaid |
$135.58
|
| Rate for Payer: Kentucky WC Medicaid |
$136.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.94
|
| Rate for Payer: Ohio Health Group HMO |
$295.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.03
|
| Rate for Payer: PHCS Commercial |
$378.48
|
| Rate for Payer: United Healthcare All Payer |
$346.94
|
|
|
NOVOLOG FLX PN 300 U/3ML EA 5U
|
Facility
|
OP
|
$152.27
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$146.18 |
| Rate for Payer: Aetna Commercial |
$117.25
|
| Rate for Payer: Anthem Medicaid |
$52.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.77
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cigna Commercial |
$126.38
|
| Rate for Payer: First Health Commercial |
$144.66
|
| Rate for Payer: Humana Commercial |
$129.43
|
| Rate for Payer: Humana KY Medicaid |
$52.37
|
| Rate for Payer: Kentucky WC Medicaid |
$52.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.00
|
| Rate for Payer: Ohio Health Group HMO |
$114.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.07
|
| Rate for Payer: PHCS Commercial |
$146.18
|
| Rate for Payer: United Healthcare All Payer |
$134.00
|
|
|
NOVOLOG FLX PN 300 U/3ML EA 5U
|
Facility
|
IP
|
$152.27
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$146.18 |
| Rate for Payer: Aetna Commercial |
$117.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.77
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cigna Commercial |
$126.38
|
| Rate for Payer: First Health Commercial |
$144.66
|
| Rate for Payer: Humana Commercial |
$129.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.00
|
| Rate for Payer: Ohio Health Group HMO |
$114.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.07
|
| Rate for Payer: PHCS Commercial |
$146.18
|
| Rate for Payer: United Healthcare All Payer |
$134.00
|
|
|
NovoLOG MIX 70-30 VIAL 10mL
|
Facility
|
IP
|
$307.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$295.05 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.73
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna Commercial |
$255.09
|
| Rate for Payer: First Health Commercial |
$291.97
|
| Rate for Payer: Humana Commercial |
$261.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$252.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.46
|
| Rate for Payer: Ohio Health Group HMO |
$230.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.06
|
| Rate for Payer: PHCS Commercial |
$295.05
|
| Rate for Payer: United Healthcare All Payer |
$270.46
|
|
|
NovoLOG MIX 70-30 VIAL 10mL
|
Facility
|
OP
|
$307.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$295.05 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Anthem Medicaid |
$105.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.73
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna Commercial |
$255.09
|
| Rate for Payer: First Health Commercial |
$291.97
|
| Rate for Payer: Humana Commercial |
$261.24
|
| Rate for Payer: Humana KY Medicaid |
$105.69
|
| Rate for Payer: Kentucky WC Medicaid |
$106.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$252.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.46
|
| Rate for Payer: Ohio Health Group HMO |
$230.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.06
|
| Rate for Payer: PHCS Commercial |
$295.05
|
| Rate for Payer: United Healthcare All Payer |
$270.46
|
|
|
NOVOSEVEN RT 1 MCG (2MG VIAL)
|
Facility
|
IP
|
$78.81
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
25002475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Aetna Commercial |
$60.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.47
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cigna Commercial |
$65.41
|
| Rate for Payer: First Health Commercial |
$74.87
|
| Rate for Payer: Humana Commercial |
$66.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.35
|
| Rate for Payer: Ohio Health Group HMO |
$59.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.38
|
| Rate for Payer: PHCS Commercial |
$75.66
|
| Rate for Payer: United Healthcare All Payer |
$69.35
|
|
|
NOVOSEVEN RT 1 MCG (2MG VIAL)
|
Facility
|
OP
|
$78.81
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
25002475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Aetna Commercial |
$60.68
|
| Rate for Payer: Anthem Medicaid |
$27.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.58
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cigna Commercial |
$65.41
|
| Rate for Payer: First Health Commercial |
$74.87
|
| Rate for Payer: Humana Commercial |
$66.99
|
| Rate for Payer: Humana KY Medicaid |
$27.10
|
| Rate for Payer: Humana Medicare Advantage |
$2.65
|
| Rate for Payer: Kentucky WC Medicaid |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.35
|
| Rate for Payer: Ohio Health Group HMO |
$59.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.38
|
| Rate for Payer: PHCS Commercial |
$75.66
|
| Rate for Payer: United Healthcare All Payer |
$69.35
|
|
|
NOV PULSE GEN NON RECHARGEABLE
|
Facility
|
OP
|
$91,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,432.00 |
| Max. Negotiated Rate |
$87,782.40 |
| Rate for Payer: Aetna Commercial |
$70,408.80
|
| Rate for Payer: Anthem Medicaid |
$31,446.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,323.20
|
| Rate for Payer: Cash Price |
$45,720.00
|
| Rate for Payer: Cigna Commercial |
$75,895.20
|
| Rate for Payer: First Health Commercial |
$86,868.00
|
| Rate for Payer: Humana Commercial |
$77,724.00
|
| Rate for Payer: Humana KY Medicaid |
$31,446.22
|
| Rate for Payer: Kentucky WC Medicaid |
$31,766.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,482.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,432.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,077.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$68,580.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,552.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,093.60
|
| Rate for Payer: PHCS Commercial |
$87,782.40
|
| Rate for Payer: United Healthcare All Payer |
$80,467.20
|
|
|
NOV PULSE GEN NON RECHARGEABLE
|
Facility
|
IP
|
$91,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,432.00 |
| Max. Negotiated Rate |
$87,782.40 |
| Rate for Payer: Aetna Commercial |
$70,408.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,323.20
|
| Rate for Payer: Cash Price |
$45,720.00
|
| Rate for Payer: Cigna Commercial |
$75,895.20
|
| Rate for Payer: First Health Commercial |
$86,868.00
|
| Rate for Payer: Humana Commercial |
$77,724.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,482.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$68,580.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,552.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,093.60
|
| Rate for Payer: PHCS Commercial |
$87,782.40
|
| Rate for Payer: United Healthcare All Payer |
$80,467.20
|
|
|
NPLATE 1mcg (125mcg SDV)
|
Facility
|
IP
|
$7,502.09
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25004205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,250.63 |
| Max. Negotiated Rate |
$7,202.01 |
| Rate for Payer: Aetna Commercial |
$5,776.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,851.63
|
| Rate for Payer: Cash Price |
$3,751.04
|
| Rate for Payer: Cigna Commercial |
$6,226.73
|
| Rate for Payer: First Health Commercial |
$7,126.99
|
| Rate for Payer: Humana Commercial |
$6,376.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,151.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,536.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,250.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,601.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,626.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,001.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,526.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,176.44
|
| Rate for Payer: PHCS Commercial |
$7,202.01
|
| Rate for Payer: United Healthcare All Payer |
$6,601.84
|
|
|
NPLATE 1mcg (125mcg SDV)
|
Facility
|
OP
|
$7,502.09
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25004205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$7,202.01 |
| Rate for Payer: Aetna Commercial |
$5,776.61
|
| Rate for Payer: Anthem Medicaid |
$2,579.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,851.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.85
|
| Rate for Payer: Cash Price |
$3,751.04
|
| Rate for Payer: Cash Price |
$3,751.04
|
| Rate for Payer: Cigna Commercial |
$6,226.73
|
| Rate for Payer: First Health Commercial |
$7,126.99
|
| Rate for Payer: Humana Commercial |
$6,376.78
|
| Rate for Payer: Humana KY Medicaid |
$2,579.97
|
| Rate for Payer: Humana Medicare Advantage |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,606.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,151.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,536.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,631.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,601.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,626.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,001.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,526.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,176.44
|
| Rate for Payer: PHCS Commercial |
$7,202.01
|
| Rate for Payer: United Healthcare All Payer |
$6,601.84
|
|
