|
NANOCROSS ELITE 6*100
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS ELITE 6*100
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS ELITE 6*40
|
Facility
|
IP
|
$3,300.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.28 |
| Max. Negotiated Rate |
$3,168.91 |
| Rate for Payer: Aetna Commercial |
$2,541.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.74
|
| Rate for Payer: Cash Price |
$1,650.47
|
| Rate for Payer: Cigna Commercial |
$2,739.79
|
| Rate for Payer: First Health Commercial |
$3,135.90
|
| Rate for Payer: Humana Commercial |
$2,805.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.66
|
| Rate for Payer: PHCS Commercial |
$3,168.91
|
| Rate for Payer: United Healthcare All Payer |
$2,904.84
|
|
|
NANOCROSS ELITE 6*40
|
Facility
|
OP
|
$3,300.95
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.28 |
| Max. Negotiated Rate |
$3,168.91 |
| Rate for Payer: Aetna Commercial |
$2,541.73
|
| Rate for Payer: Anthem Medicaid |
$1,135.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.74
|
| Rate for Payer: Cash Price |
$1,650.47
|
| Rate for Payer: Cigna Commercial |
$2,739.79
|
| Rate for Payer: First Health Commercial |
$3,135.90
|
| Rate for Payer: Humana Commercial |
$2,805.81
|
| Rate for Payer: Humana KY Medicaid |
$1,135.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.66
|
| Rate for Payer: PHCS Commercial |
$3,168.91
|
| Rate for Payer: United Healthcare All Payer |
$2,904.84
|
|
|
NANOCROSS OTW PTA 2*40*150
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS OTW PTA 2*40*150
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS OTW PTA 2.5*40*150
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCROSS OTW PTA 2.5*40*150
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCRS.014 OTWPTA 3*3.5*210CM
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANOCRS.014 OTWPTA 3*3.5*210CM
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
NANO SWIVELOCK 2.5X7MM W/FORKT
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
NANO SWIVELOCK 2.5X7MM W/FORKT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
NAPHCON-A (NAPH/PHENIR) O 15ML
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
25001048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| 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 |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| 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
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
25001048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| 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 |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| 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
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
25001049
|
|
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
|
|
|
NAPROSYN (NAPROXEN) 250MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
25001049
|
|
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
|
|
|
NAPROSYN (NAPROXEN) 375MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 65162018910
|
| Hospital Charge Code |
25001050
|
|
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
|
|
|
NAPROSYN (NAPROXEN) 375MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 65162018910
|
| Hospital Charge Code |
25001050
|
|
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
|
|
|
NAROPIN 1% 20ML AMP
|
Facility
|
IP
|
$129.70
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$124.51 |
| 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
|
| Rate for Payer: Humana Commercial |
$110.25
|
| 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 |
$103.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.49
|
| Rate for Payer: PHCS Commercial |
$124.51
|
| Rate for Payer: United Healthcare All Payer |
$114.14
|
|
|
NAROPIN 1% 20ML AMP
|
Facility
|
OP
|
$129.70
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25003906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.91 |
| 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 |
$110.25
|
| 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 |
$103.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.49
|
| Rate for Payer: PHCS Commercial |
$124.51
|
| Rate for Payer: United Healthcare All Payer |
$114.14
|
|
|
NAROPIN 1MG (150MG/30ML) VIAL
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
NAROPIN 1MG (150MG/30ML) VIAL
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.09
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.64
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.88
|
| Rate for Payer: United Healthcare All Payer |
$101.64
|
|
|
NAROPIN 1 MG (200MG VIAL)
|
Facility
|
IP
|
$194.63
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.81
|
| Rate for Payer: Cash Price |
$97.32
|
| Rate for Payer: Cigna Commercial |
$161.54
|
| Rate for Payer: First Health Commercial |
$184.90
|
| Rate for Payer: Humana Commercial |
$165.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.27
|
| Rate for Payer: Ohio Health Group HMO |
$145.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.29
|
| Rate for Payer: PHCS Commercial |
$186.84
|
| Rate for Payer: United Healthcare All Payer |
$171.27
|
|
|
NAROPIN 1 MG (200MG VIAL)
|
Facility
|
OP
|
$194.63
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Anthem Medicaid |
$66.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.81
|
| Rate for Payer: Cash Price |
$97.32
|
| Rate for Payer: Cigna Commercial |
$161.54
|
| Rate for Payer: First Health Commercial |
$184.90
|
| Rate for Payer: Humana Commercial |
$165.44
|
| Rate for Payer: Humana KY Medicaid |
$66.93
|
| Rate for Payer: Kentucky WC Medicaid |
$67.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.27
|
| Rate for Payer: Ohio Health Group HMO |
$145.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.29
|
| Rate for Payer: PHCS Commercial |
$186.84
|
| Rate for Payer: United Healthcare All Payer |
$171.27
|
|
|
NAROPIN (ROPIVACAINE)7.5MG/ML
|
Facility
|
IP
|
$125.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
25002351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Aetna Commercial |
$96.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.20
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: First Health Commercial |
$119.61
|
| Rate for Payer: Humana Commercial |
$107.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.79
|
| Rate for Payer: Ohio Health Group HMO |
$94.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.87
|
| Rate for Payer: PHCS Commercial |
$120.86
|
| Rate for Payer: United Healthcare All Payer |
$110.79
|
|
