|
NIFEREX-150 (IRON) 150MG/1CAP
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 904539561
|
| Hospital Charge Code |
25001084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
NIFEREX-150 (IRON) 150MG/1CAP
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 904539561
|
| Hospital Charge Code |
25001084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
NIMBEX(CISTRACURIUM) 20MG/10ML
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
NDC 781315295
|
| Hospital Charge Code |
25003271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
NIMBEX(CISTRACURIUM) 20MG/10ML
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
NDC 781315295
|
| Hospital Charge Code |
25003271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
NIMOTOP (NIMODIPINE) 30MG/1CAP
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 57664013564
|
| Hospital Charge Code |
25001085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
NIMOTOP (NIMODIPINE) 30MG/1CAP
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 57664013564
|
| Hospital Charge Code |
25001085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$7.57
|
| Rate for Payer: Kentucky WC Medicaid |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
NIPENT (PENTOSTATIN) 10 MG VL
|
Facility
|
IP
|
$16,084.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
25002656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,825.34 |
| Max. Negotiated Rate |
$15,441.10 |
| Rate for Payer: Aetna Commercial |
$12,385.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,545.89
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cigna Commercial |
$13,350.12
|
| Rate for Payer: First Health Commercial |
$15,280.26
|
| Rate for Payer: Humana Commercial |
$13,671.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,189.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,870.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,825.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,154.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,063.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,867.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,993.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,098.29
|
| Rate for Payer: PHCS Commercial |
$15,441.10
|
| Rate for Payer: United Healthcare All Payer |
$14,154.34
|
|
|
NIPENT (PENTOSTATIN) 10 MG VL
|
Facility
|
OP
|
$16,084.48
|
|
|
Service Code
|
HCPCS J9268
|
| Hospital Charge Code |
25002656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,543.89 |
| Max. Negotiated Rate |
$15,441.10 |
| Rate for Payer: Aetna Commercial |
$12,385.05
|
| Rate for Payer: Anthem Medicaid |
$5,531.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,543.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,545.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,561.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,434.25
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cash Price |
$8,042.24
|
| Rate for Payer: Cigna Commercial |
$13,350.12
|
| Rate for Payer: First Health Commercial |
$15,280.26
|
| Rate for Payer: Humana Commercial |
$13,671.81
|
| Rate for Payer: Humana KY Medicaid |
$5,531.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,543.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,587.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,189.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,870.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,052.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,642.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,154.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,063.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,867.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,993.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,098.29
|
| Rate for Payer: PHCS Commercial |
$15,441.10
|
| Rate for Payer: United Healthcare All Payer |
$14,154.34
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.13 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$983.82
|
| Rate for Payer: Ambetter Exchange |
$637.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$457.13
|
| Rate for Payer: Anthem Medicaid |
$464.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$637.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$637.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.42
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$947.40
|
| Rate for Payer: Healthspan PPO |
$959.97
|
| Rate for Payer: Humana Medicaid |
$464.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.63
|
| Rate for Payer: Molina Healthcare Passport |
$464.34
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$828.13
|
| Rate for Payer: UHCCP Medicaid |
$479.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$637.02
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.70 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19350
|
| Hospital Charge Code |
76100313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
NIPPLE/AREOLA RECONSTRUCTION(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
761P0313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.13 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$983.82
|
| Rate for Payer: Ambetter Exchange |
$637.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$457.13
|
| Rate for Payer: Anthem Medicaid |
$464.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$637.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$637.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.42
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$947.40
|
| Rate for Payer: Healthspan PPO |
$959.97
|
| Rate for Payer: Humana Medicaid |
$464.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.63
|
| Rate for Payer: Molina Healthcare Passport |
$464.34
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$828.13
|
| Rate for Payer: UHCCP Medicaid |
$479.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$637.02
|
|
|
NIPPLE EXPLORATION EXC
|
Professional
|
Both
|
$6,918.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
76100286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.69 |
| Max. Negotiated Rate |
$4,150.80 |
| Rate for Payer: Aetna Commercial |
$461.36
|
| Rate for Payer: Ambetter Exchange |
$335.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$181.69
|
| Rate for Payer: Anthem Medicaid |
$200.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$335.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$402.19
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cigna Commercial |
$426.37
|
| Rate for Payer: Healthspan PPO |
$498.57
|
| Rate for Payer: Humana Medicaid |
$200.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$335.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.15
|
| Rate for Payer: Molina Healthcare Passport |
$200.15
|
| Rate for Payer: Multiplan PHCS |
$4,150.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.71
|
| Rate for Payer: UHCCP Medicaid |
$190.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$335.16
|
|
|
NIPPLE EXPLORATION EXC
|
Facility
|
IP
|
$6,918.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
76100286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,075.40 |
| Max. Negotiated Rate |
$6,641.28 |
| Rate for Payer: Aetna Commercial |
$5,326.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.04
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cigna Commercial |
$5,741.94
|
| Rate for Payer: First Health Commercial |
$6,572.10
|
| Rate for Payer: Humana Commercial |
$5,880.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,672.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,105.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,087.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,188.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,018.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,773.42
|
| Rate for Payer: PHCS Commercial |
$6,641.28
|
| Rate for Payer: United Healthcare All Payer |
$6,087.84
|
|
|
NIPPLE EXPLORATION EXC
|
Facility
|
OP
|
$6,918.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
76100286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,379.10 |
| Max. Negotiated Rate |
$6,641.28 |
| Rate for Payer: Aetna Commercial |
$5,326.86
|
| Rate for Payer: Anthem Medicaid |
$2,379.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cigna Commercial |
$5,741.94
|
| Rate for Payer: First Health Commercial |
$6,572.10
|
| Rate for Payer: Humana Commercial |
$5,880.30
|
| Rate for Payer: Humana KY Medicaid |
$2,379.10
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,403.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,672.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,105.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,426.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,087.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,188.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,018.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,773.42
|
| Rate for Payer: PHCS Commercial |
$6,641.28
|
| Rate for Payer: United Healthcare All Payer |
$6,087.84
|
|
|
NIPPLE EXPLORATION EXC(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
761P0286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.69 |
| Max. Negotiated Rate |
$498.57 |
| Rate for Payer: Aetna Commercial |
$461.36
|
| Rate for Payer: Ambetter Exchange |
$335.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$181.69
|
| Rate for Payer: Anthem Medicaid |
$200.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$335.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$402.19
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$426.37
|
| Rate for Payer: Healthspan PPO |
$498.57
|
| Rate for Payer: Humana Medicaid |
$200.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$335.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.15
|
| Rate for Payer: Molina Healthcare Passport |
$200.15
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.71
|
| Rate for Payer: UHCCP Medicaid |
$190.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$335.16
|
|
|
NIPPLE EXPLORATION EXC(T
|
Facility
|
IP
|
$6,218.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
761T0286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,865.40 |
| Max. Negotiated Rate |
$5,969.28 |
| Rate for Payer: Aetna Commercial |
$4,787.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,850.04
|
| Rate for Payer: Cash Price |
$3,109.00
|
| Rate for Payer: Cigna Commercial |
$5,160.94
|
| Rate for Payer: First Health Commercial |
$5,907.10
|
| Rate for Payer: Humana Commercial |
$5,285.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,098.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,588.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,865.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,471.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,663.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,409.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,290.42
|
| Rate for Payer: PHCS Commercial |
$5,969.28
|
| Rate for Payer: United Healthcare All Payer |
$5,471.84
|
|
|
NIPPLE EXPLORATION EXC(T
|
Facility
|
OP
|
$6,218.00
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
761T0286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,138.37 |
| Max. Negotiated Rate |
$5,969.28 |
| Rate for Payer: Aetna Commercial |
$4,787.86
|
| Rate for Payer: Anthem Medicaid |
$2,138.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,850.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,109.00
|
| Rate for Payer: Cash Price |
$3,109.00
|
| Rate for Payer: Cigna Commercial |
$5,160.94
|
| Rate for Payer: First Health Commercial |
$5,907.10
|
| Rate for Payer: Humana Commercial |
$5,285.30
|
| Rate for Payer: Humana KY Medicaid |
$2,138.37
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,160.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,098.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,588.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,181.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,471.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,663.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,409.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,290.42
|
| Rate for Payer: PHCS Commercial |
$5,969.28
|
| Rate for Payer: United Healthcare All Payer |
$5,471.84
|
|
|
NIPRIDE KIT FOR CARD
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
25003273
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
NIPRIDE KIT FOR CARD
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
NDC 25021031002
|
| Hospital Charge Code |
25003273
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem Medicaid |
$191.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Humana KY Medicaid |
$191.90
|
| Rate for Payer: Kentucky WC Medicaid |
$193.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
NIPRIDE (SOD NITROPRU 50MG/2ML
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003272
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$63.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$63.97
|
| Rate for Payer: Kentucky WC Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
NIPRIDE (SOD NITROPRU 50MG/2ML
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003272
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
NIRXCELL STENT 2.5*12
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
