|
NANOCROSS OTW PTA 2*40*150
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANOCROSS OTW PTA 2*40*150
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANOCROSS OTW PTA 2.5*40*150
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANOCROSS OTW PTA 2.5*40*150
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANOCRS.014 OTWPTA 3*3.5*210CM
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANOCRS.014 OTWPTA 3*3.5*210CM
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
NANO SWIVELOCK 2.5X7MM W/FORKT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
NANO SWIVELOCK 2.5X7MM W/FORKT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
NAPHCON-A (NAPH/PHENIR) O 15ML
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
25001048
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.02
|
| Rate for Payer: Humana Commercial |
$0.02
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.02
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Payer |
$0.02
|
|
|
NAPHCON-A (NAPH/PHENIR) O 15ML
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
25001048
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.02
|
| Rate for Payer: Humana Commercial |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.02
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Payer |
$0.02
|
|
|
NAPROSYN (NAPROXEN) 250MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
25001049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NAPROSYN (NAPROXEN) 250MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
25001049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem 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 |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NAPROSYN (NAPROXEN) 375MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 65162018910
|
| Hospital Charge Code |
25001050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
| 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
|
|
|
NAPROSYN (NAPROXEN) 375MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 65162018910
|
| Hospital Charge Code |
25001050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem 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 |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
NARCAN(NALOXONE) 0.4M .4MG/2ML
|
Facility
|
IP
|
$86.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
25002257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$82.82 |
| Rate for Payer: Aetna Commercial |
$66.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.29
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna Commercial |
$71.60
|
| Rate for Payer: First Health Commercial |
$81.96
|
| Rate for Payer: Humana Commercial |
$73.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.92
|
| Rate for Payer: Ohio Health Group HMO |
$64.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.74
|
| Rate for Payer: PHCS Commercial |
$82.82
|
| Rate for Payer: United Healthcare All Payer |
$75.92
|
|
|
NARCAN(NALOXONE) 0.4M .4MG/2ML
|
Facility
|
OP
|
$86.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
25002257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$82.82 |
| Rate for Payer: Aetna Commercial |
$66.43
|
| Rate for Payer: Anthem Medicaid |
$29.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.29
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna Commercial |
$71.60
|
| Rate for Payer: First Health Commercial |
$81.96
|
| Rate for Payer: Humana Commercial |
$73.33
|
| Rate for Payer: Humana KY Medicaid |
$29.67
|
| Rate for Payer: Kentucky WC Medicaid |
$29.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.92
|
| Rate for Payer: Ohio Health Group HMO |
$64.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.74
|
| Rate for Payer: PHCS Commercial |
$82.82
|
| Rate for Payer: United Healthcare All Payer |
$75.92
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
636T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$86.88 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.59
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna Commercial |
$75.12
|
| Rate for Payer: First Health Commercial |
$85.98
|
| Rate for Payer: Humana Commercial |
$76.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.64
|
| Rate for Payer: Ohio Health Group HMO |
$67.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.06
|
| Rate for Payer: PHCS Commercial |
$86.88
|
| Rate for Payer: United Healthcare All Payer |
$79.64
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
63600044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$86.88 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.59
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna Commercial |
$75.12
|
| Rate for Payer: First Health Commercial |
$85.98
|
| Rate for Payer: Humana Commercial |
$76.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.64
|
| Rate for Payer: Ohio Health Group HMO |
$67.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.06
|
| Rate for Payer: PHCS Commercial |
$86.88
|
| Rate for Payer: United Healthcare All Payer |
$79.64
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
25002258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
63600044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$86.88 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Anthem Medicaid |
$31.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.59
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna Commercial |
$75.12
|
| Rate for Payer: First Health Commercial |
$85.98
|
| Rate for Payer: Humana Commercial |
$76.92
|
| Rate for Payer: Humana KY Medicaid |
$31.12
|
| Rate for Payer: Kentucky WC Medicaid |
$31.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.64
|
| Rate for Payer: Ohio Health Group HMO |
$67.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.06
|
| Rate for Payer: PHCS Commercial |
$86.88
|
| Rate for Payer: United Healthcare All Payer |
$79.64
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Professional
|
Both
|
$90.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
63600044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$90.50 |
| Rate for Payer: Aetna Commercial |
$14.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.50
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.24
|
| Rate for Payer: Multiplan PHCS |
$54.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.35
|
| Rate for Payer: UHCCP Medicaid |
$31.68
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
636T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$86.88 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Anthem Medicaid |
$31.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.59
|
| Rate for Payer: Cash Price |
$45.25
|
| Rate for Payer: Cigna Commercial |
$75.12
|
| Rate for Payer: First Health Commercial |
$85.98
|
| Rate for Payer: Humana Commercial |
$76.92
|
| Rate for Payer: Humana KY Medicaid |
$31.12
|
| Rate for Payer: Kentucky WC Medicaid |
$31.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.64
|
| Rate for Payer: Ohio Health Group HMO |
$67.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.06
|
| Rate for Payer: PHCS Commercial |
$86.88
|
| Rate for Payer: United Healthcare All Payer |
$79.64
|
|
|
NARCAN(NALOXONE 1MG/ML(2MG/2ML
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
25002258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$65.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$65.00
|
| Rate for Payer: Kentucky WC Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
NAROPIN 1% 20ML AMP
|
Facility
|
IP
|
$129.70
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Humana Commercial |
$110.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.14
|
| Rate for Payer: Ohio Health Group HMO |
$97.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.21
|
| Rate for Payer: PHCS Commercial |
$124.51
|
| Rate for Payer: United Healthcare All Payer |
$114.14
|
| Rate for Payer: Aetna Commercial |
$99.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.17
|
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Cigna Commercial |
$107.65
|
| Rate for Payer: First Health Commercial |
$123.22
|
|
|
NAROPIN 1% 20ML AMP
|
Facility
|
OP
|
$129.70
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Aetna Commercial |
$99.87
|
| Rate for Payer: Anthem Medicaid |
$44.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.17
|
| Rate for Payer: Cash Price |
$64.85
|
| Rate for Payer: Cigna Commercial |
$107.65
|
| Rate for Payer: First Health Commercial |
$123.22
|
| Rate for Payer: Humana Commercial |
$110.24
|
| Rate for Payer: Humana KY Medicaid |
$44.60
|
| Rate for Payer: Kentucky WC Medicaid |
$45.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.14
|
| Rate for Payer: Ohio Health Group HMO |
$97.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.21
|
| Rate for Payer: PHCS Commercial |
$124.51
|
| Rate for Payer: United Healthcare All Payer |
$114.14
|
|
