|
PRECEDEX 4MCG/ML BOTTLE 100ML
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem Medicaid |
$109.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.82
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Humana KY Medicaid |
$109.70
|
| Rate for Payer: Kentucky WC Medicaid |
$110.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.89
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
PRECEDEX 4MCG/ML BOTTLE 100ML
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.82
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.89
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
PRECEDEX 4MCG/ML BOTTLE 50ML
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$63.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$63.28
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
PRECEDEX 4MCG/ML BOTTLE 50ML
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
PRECEDEX(DEXAME HCL)200MCG/2ML
|
Facility
|
OP
|
$114.20
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
25003372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$109.63 |
| Rate for Payer: Humana Commercial |
$97.07
|
| Rate for Payer: Humana KY Medicaid |
$39.27
|
| Rate for Payer: Kentucky WC Medicaid |
$39.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.50
|
| Rate for Payer: Ohio Health Group HMO |
$85.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.40
|
| Rate for Payer: PHCS Commercial |
$109.63
|
| Rate for Payer: United Healthcare All Payer |
$100.50
|
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Anthem Medicaid |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.08
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Cigna Commercial |
$94.79
|
| Rate for Payer: First Health Commercial |
$108.49
|
|
|
PRECEDEX(DEXAME HCL)200MCG/2ML
|
Facility
|
IP
|
$114.20
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
25003372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$109.63 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.08
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Cigna Commercial |
$94.79
|
| Rate for Payer: First Health Commercial |
$108.49
|
| Rate for Payer: Humana Commercial |
$97.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.50
|
| Rate for Payer: Ohio Health Group HMO |
$85.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.40
|
| Rate for Payer: PHCS Commercial |
$109.63
|
| Rate for Payer: United Healthcare All Payer |
$100.50
|
|
|
PRECEDEX (F S) 200MCG 2ML VIAL
|
Facility
|
OP
|
$112.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Anthem Medicaid |
$38.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.69
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cigna Commercial |
$93.31
|
| Rate for Payer: First Health Commercial |
$106.80
|
| Rate for Payer: Humana Commercial |
$95.56
|
| Rate for Payer: Humana KY Medicaid |
$38.66
|
| Rate for Payer: Kentucky WC Medicaid |
$39.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.93
|
| Rate for Payer: Ohio Health Group HMO |
$84.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.85
|
| Rate for Payer: PHCS Commercial |
$107.92
|
| Rate for Payer: United Healthcare All Payer |
$98.93
|
|
|
PRECEDEX (F S) 200MCG 2ML VIAL
|
Facility
|
IP
|
$112.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.92 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.69
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cigna Commercial |
$93.31
|
| Rate for Payer: First Health Commercial |
$106.80
|
| Rate for Payer: Humana Commercial |
$95.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.93
|
| Rate for Payer: Ohio Health Group HMO |
$84.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.85
|
| Rate for Payer: PHCS Commercial |
$107.92
|
| Rate for Payer: United Healthcare All Payer |
$98.93
|
|
|
PRECISE STENT 5*40
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PRECISE STENT 5*40
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PRECISION ACCESS 5FR
|
Facility
|
OP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem Medicaid |
$1,147.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Humana KY Medicaid |
$1,147.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
PRECISION ACCESS 5FR
|
Facility
|
IP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
PRECISION ACCESS 6FR
|
Facility
|
IP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
PRECISION ACCESS 6FR
|
Facility
|
OP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem Medicaid |
$1,147.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Humana KY Medicaid |
$1,147.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
PRECISION NERVE PULSE GEN KIT
|
Facility
|
OP
|
$81,862.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,642.06 |
| Max. Negotiated Rate |
$78,587.52 |
| Rate for Payer: Aetna Commercial |
$63,033.74
|
| Rate for Payer: Anthem Medicaid |
$28,152.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,852.36
|
| Rate for Payer: Cash Price |
$40,931.00
|
| Rate for Payer: Cigna Commercial |
$67,945.46
|
| Rate for Payer: First Health Commercial |
$77,768.90
|
| Rate for Payer: Humana Commercial |
$69,582.70
|
| Rate for Payer: Humana KY Medicaid |
$28,152.34
|
| Rate for Payer: Kentucky WC Medicaid |
$28,438.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,126.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,414.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,558.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,717.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,038.56
|
| Rate for Payer: Ohio Health Group HMO |
$61,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,372.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,377.22
|
| Rate for Payer: PHCS Commercial |
$78,587.52
|
| Rate for Payer: United Healthcare All Payer |
$72,038.56
|
|
|
PRECISION NERVE PULSE GEN KIT
|
Facility
|
IP
|
$81,862.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,642.06 |
| Max. Negotiated Rate |
$78,587.52 |
| Rate for Payer: Aetna Commercial |
$63,033.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,852.36
|
| Rate for Payer: Cash Price |
$40,931.00
|
| Rate for Payer: Cigna Commercial |
$67,945.46
|
| Rate for Payer: First Health Commercial |
$77,768.90
|
| Rate for Payer: Humana Commercial |
$69,582.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,126.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,414.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,558.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,038.56
|
| Rate for Payer: Ohio Health Group HMO |
$61,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,372.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,377.22
|
| Rate for Payer: PHCS Commercial |
$78,587.52
|
| Rate for Payer: United Healthcare All Payer |
$72,038.56
|
|
|
PRECISION PT PROGRAMMER KIT
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PRECISION PT PROGRAMMER KIT
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PRECOSE (ACARBOSE) 25MG TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 23155014701
|
| Hospital Charge Code |
25001211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
PRECOSE (ACARBOSE) 25MG TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 23155014701
|
| Hospital Charge Code |
25001211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
PRECOSE (ACARBOSE) 5 50MG/1TAB
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 64380075906
|
| Hospital Charge Code |
25001212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
PRECOSE (ACARBOSE) 5 50MG/1TAB
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 64380075906
|
| Hospital Charge Code |
25001212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
PRED FORTE (PREDNISOLONE)O 5ML
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
25001213
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem Medicaid |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Humana KY Medicaid |
$0.67
|
| Rate for Payer: Kentucky WC Medicaid |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
PRED FORTE (PREDNISOLONE)O 5ML
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
25001213
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
PREDNISONE 10MG (10MG/1 TAB)
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
