|
NSPACE BALLOON IMPLANT - SMALL
|
Facility
|
OP
|
$28,525.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,708.25 |
| Max. Negotiated Rate |
$27,384.00 |
| Rate for Payer: Aetna Commercial |
$21,964.25
|
| Rate for Payer: Anthem Medicaid |
$9,809.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,249.50
|
| Rate for Payer: Cash Price |
$14,262.50
|
| Rate for Payer: Cigna Commercial |
$23,675.75
|
| Rate for Payer: First Health Commercial |
$27,098.75
|
| Rate for Payer: Humana Commercial |
$24,246.25
|
| Rate for Payer: Humana KY Medicaid |
$9,809.75
|
| Rate for Payer: Kentucky WC Medicaid |
$9,909.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,390.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,051.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,557.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,006.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,102.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,705.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,842.75
|
| Rate for Payer: PHCS Commercial |
$27,384.00
|
| Rate for Payer: United Healthcare All Payer |
$25,102.00
|
|
|
NT PRO BNP P
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem Medicaid |
$39.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.26
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Humana KY Medicaid |
$39.26
|
| Rate for Payer: Humana Medicare Advantage |
$39.26
|
| Rate for Payer: Kentucky WC Medicaid |
$39.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
NT PRO BNP P
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.63
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$24.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$24.07
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Anthem Medicaid |
$28.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$28.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.37
|
| Rate for Payer: Molina Healthcare Passport |
$28.79
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.08
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
761P2635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Anthem Medicaid |
$28.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$28.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.37
|
| Rate for Payer: Molina Healthcare Passport |
$28.79
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.08
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
761P2633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Anthem Medicaid |
$43.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$43.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Molina Healthcare Passport |
$43.32
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.75
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Anthem Medicaid |
$43.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$43.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Molina Healthcare Passport |
$43.32
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.75
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
NUBAIN(NALBUPHINE)10M 10MG/1ML
|
Facility
|
OP
|
$79.86
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
25002256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$27.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.29
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna Commercial |
$66.28
|
| Rate for Payer: First Health Commercial |
$75.87
|
| Rate for Payer: Humana Commercial |
$67.88
|
| Rate for Payer: Humana KY Medicaid |
$27.46
|
| Rate for Payer: Kentucky WC Medicaid |
$27.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.76
|
| Rate for Payer: PHCS Commercial |
$76.67
|
| Rate for Payer: United Healthcare All Payer |
$70.28
|
|
|
NUBAIN(NALBUPHINE)10M 10MG/1ML
|
Facility
|
IP
|
$79.86
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
25002256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$61.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.29
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna Commercial |
$66.28
|
| Rate for Payer: First Health Commercial |
$75.87
|
| Rate for Payer: Humana Commercial |
$67.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.76
|
| Rate for Payer: PHCS Commercial |
$76.67
|
| Rate for Payer: United Healthcare All Payer |
$70.28
|
|
|
NUCALA 1 MG (100 MG VIAL)
|
Facility
|
OP
|
$5,212.92
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
25002225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$5,004.40 |
| Rate for Payer: Aetna Commercial |
$4,013.95
|
| Rate for Payer: Anthem Medicaid |
$1,792.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,066.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$42.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.18
|
| Rate for Payer: Cash Price |
$2,606.46
|
| Rate for Payer: Cash Price |
$2,606.46
|
| Rate for Payer: Cigna Commercial |
$4,326.72
|
| Rate for Payer: First Health Commercial |
$4,952.27
|
| Rate for Payer: Humana Commercial |
$4,430.98
|
| Rate for Payer: Humana KY Medicaid |
$1,792.72
|
| Rate for Payer: Humana Medicare Advantage |
$30.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,810.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,274.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,847.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,828.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,587.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,909.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,616.01
|
| Rate for Payer: PHCS Commercial |
$5,004.40
|
| Rate for Payer: United Healthcare All Payer |
$4,587.37
|
|
|
NUCALA 1 MG (100 MG VIAL)
|
Facility
|
IP
|
$5,212.92
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
25002225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$677.68 |
| Max. Negotiated Rate |
$5,004.40 |
| Rate for Payer: Humana Commercial |
$4,430.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,274.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,847.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,587.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,909.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,616.01
|
| Rate for Payer: PHCS Commercial |
$5,004.40
|
| Rate for Payer: United Healthcare All Payer |
$4,587.37
|
| Rate for Payer: Aetna Commercial |
$4,013.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,066.08
|
| Rate for Payer: Cash Price |
$2,606.46
|
| Rate for Payer: Cigna Commercial |
$4,326.72
|
| Rate for Payer: First Health Commercial |
$4,952.27
|
|
|
NUCYNTA 100MG TABLET PO
|
Facility
|
OP
|
$76.48
|
|
|
Service Code
|
NDC 24510010010
|
| Hospital Charge Code |
25001109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$73.42 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Anthem Medicaid |
$26.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.65
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: First Health Commercial |
$72.66
|
| Rate for Payer: Humana Commercial |
$65.01
|
| Rate for Payer: Humana KY Medicaid |
$26.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.30
|
| Rate for Payer: Ohio Health Group HMO |
$57.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.71
|
| Rate for Payer: PHCS Commercial |
$73.42
|
| Rate for Payer: United Healthcare All Payer |
$67.30
|
|
|
NUCYNTA 100MG TABLET PO
|
Facility
|
IP
|
$76.48
|
|
|
Service Code
|
NDC 24510010010
|
| Hospital Charge Code |
25001109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$73.42 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.65
|
| Rate for Payer: Cash Price |
$38.24
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: First Health Commercial |
$72.66
|
| Rate for Payer: Humana Commercial |
$65.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.30
|
| Rate for Payer: Ohio Health Group HMO |
$57.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.71
|
| Rate for Payer: PHCS Commercial |
$73.42
|
| Rate for Payer: United Healthcare All Payer |
$67.30
|
|
|
NUCYNTA 50MG TABLET PO
|
Facility
|
IP
|
$70.58
|
|
|
Service Code
|
NDC 24510005010
|
| Hospital Charge Code |
25001110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
|
|
NUCYNTA 50MG TABLET PO
|
Facility
|
OP
|
$70.58
|
|
|
Service Code
|
NDC 24510005010
|
| Hospital Charge Code |
25001110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem Medicaid |
$24.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Humana KY Medicaid |
$24.27
|
| Rate for Payer: Kentucky WC Medicaid |
$24.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
|
|
NUCYNTA 75MG TABLET PO
|
Facility
|
IP
|
$72.37
|
|
|
Service Code
|
NDC 24510007510
|
| Hospital Charge Code |
25001111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$69.48 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.45
|
| Rate for Payer: Cash Price |
$36.19
|
| Rate for Payer: Cigna Commercial |
$60.07
|
| Rate for Payer: First Health Commercial |
$68.75
|
| Rate for Payer: Humana Commercial |
$61.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.69
|
| Rate for Payer: Ohio Health Group HMO |
$54.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.43
|
| Rate for Payer: PHCS Commercial |
$69.48
|
| Rate for Payer: United Healthcare All Payer |
$63.69
|
|
|
NUCYNTA 75MG TABLET PO
|
Facility
|
OP
|
$72.37
|
|
|
Service Code
|
NDC 24510007510
|
| Hospital Charge Code |
25001111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$69.48 |
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.45
|
| Rate for Payer: Cash Price |
$36.19
|
| Rate for Payer: Cigna Commercial |
$60.07
|
| Rate for Payer: First Health Commercial |
$68.75
|
| Rate for Payer: Humana Commercial |
$61.51
|
| Rate for Payer: Humana KY Medicaid |
$24.89
|
| Rate for Payer: Kentucky WC Medicaid |
$25.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.69
|
| Rate for Payer: Ohio Health Group HMO |
$54.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.43
|
| Rate for Payer: PHCS Commercial |
$69.48
|
| Rate for Payer: United Healthcare All Payer |
$63.69
|
| Rate for Payer: Aetna Commercial |
$55.72
|
|
|
NUCYNTA ER 50 MG TABLET
|
Facility
|
OP
|
$80.49
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
25003307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$77.27 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: Anthem Medicaid |
$27.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.78
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cigna Commercial |
$66.81
|
| Rate for Payer: First Health Commercial |
$76.47
|
| Rate for Payer: Humana Commercial |
$68.42
|
| Rate for Payer: Humana KY Medicaid |
$27.68
|
| Rate for Payer: Kentucky WC Medicaid |
$27.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.83
|
| Rate for Payer: Ohio Health Group HMO |
$60.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.95
|
| Rate for Payer: PHCS Commercial |
$77.27
|
| Rate for Payer: United Healthcare All Payer |
$70.83
|
|
|
NUCYNTA ER 50 MG TABLET
|
Facility
|
IP
|
$80.49
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
25003307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$77.27 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.78
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cigna Commercial |
$66.81
|
| Rate for Payer: First Health Commercial |
$76.47
|
| Rate for Payer: Humana Commercial |
$68.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.83
|
| Rate for Payer: Ohio Health Group HMO |
$60.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.95
|
| Rate for Payer: PHCS Commercial |
$77.27
|
| Rate for Payer: United Healthcare All Payer |
$70.83
|
|
|
NUPERCAINAL(DIBUCAINE) 1% 1OZ
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 536121195
|
| Hospital Charge Code |
25003308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
NUPERCAINAL(DIBUCAINE) 1% 1OZ
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 536121195
|
| Hospital Charge Code |
25003308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
