|
PREALBUMIN
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
30000482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$14.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.59
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$14.59
|
| Rate for Payer: Humana Medicare Advantage |
$14.59
|
| Rate for Payer: Kentucky WC Medicaid |
$14.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
PREALBUMIN
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
30000482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.19
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
PRECEDEX 20mcg SYR(from SDV)
|
Facility
|
OP
|
$78.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004204
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$75.36 |
| Rate for Payer: Aetna Commercial |
$60.45
|
| Rate for Payer: Anthem Medicaid |
$27.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.23
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: Cigna Commercial |
$65.16
|
| Rate for Payer: First Health Commercial |
$74.58
|
| Rate for Payer: Humana Commercial |
$66.72
|
| Rate for Payer: Humana KY Medicaid |
$27.00
|
| Rate for Payer: Kentucky WC Medicaid |
$27.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.08
|
| Rate for Payer: Ohio Health Group HMO |
$58.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.16
|
| Rate for Payer: PHCS Commercial |
$75.36
|
| Rate for Payer: United Healthcare All Payer |
$69.08
|
|
|
PRECEDEX 20mcg SYR(from SDV)
|
Facility
|
IP
|
$78.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004204
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$75.36 |
| Rate for Payer: Aetna Commercial |
$60.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.23
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: Cigna Commercial |
$65.16
|
| Rate for Payer: First Health Commercial |
$74.58
|
| Rate for Payer: Humana Commercial |
$66.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.08
|
| Rate for Payer: Ohio Health Group HMO |
$58.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.16
|
| Rate for Payer: PHCS Commercial |
$75.36
|
| Rate for Payer: United Healthcare All Payer |
$69.08
|
|
|
PRECEDEX 4MCG/ML BOTTLE 100ML
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002462
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$95.70 |
| 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 |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
PRECEDEX 4MCG/ML BOTTLE 100ML
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002462
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$95.70 |
| 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 |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
PRECEDEX 4MCG/ML BOTTLE 50ML
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002463
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.20 |
| 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 |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.96
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
PRECEDEX 4MCG/ML BOTTLE 50ML
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002463
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.20 |
| 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 |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.96
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
PRECEDEX(DEXAME HCL)200MCG/2ML
|
Facility
|
IP
|
$114.20
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
25003372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.26 |
| 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 |
$91.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.80
|
| Rate for Payer: PHCS Commercial |
$109.63
|
| Rate for Payer: United Healthcare All Payer |
$100.50
|
|
|
PRECEDEX(DEXAME HCL)200MCG/2ML
|
Facility
|
OP
|
$114.20
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
25003372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$109.63 |
| 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
|
| 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 |
$91.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.80
|
| 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
|
890
|
| Min. Negotiated Rate |
$33.73 |
| 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 |
$84.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.57
|
| 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
|
890
|
| Min. Negotiated Rate |
$33.73 |
| 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 |
$84.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.57
|
| Rate for Payer: PHCS Commercial |
$107.92
|
| Rate for Payer: United Healthcare All Payer |
$98.93
|
|
|
PRECISE STENT 5*40
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PRECISE STENT 5*40
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PRECISION ACCESS 5FR
|
Facility
|
OP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem Medicaid |
$1,106.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Humana KY Medicaid |
$1,106.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
PRECISION ACCESS 5FR
|
Facility
|
IP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
PRECISION ACCESS 6FR
|
Facility
|
OP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem Medicaid |
$1,106.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Humana KY Medicaid |
$1,106.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
PRECISION ACCESS 6FR
|
Facility
|
IP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
PRECISION NERVE PULSE GEN KIT
|
Facility
|
OP
|
$84,771.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,431.30 |
| Max. Negotiated Rate |
$81,380.16 |
| Rate for Payer: Aetna Commercial |
$65,273.67
|
| Rate for Payer: Anthem Medicaid |
$29,152.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,121.38
|
| Rate for Payer: Cash Price |
$42,385.50
|
| Rate for Payer: Cigna Commercial |
$70,359.93
|
| Rate for Payer: First Health Commercial |
$80,532.45
|
| Rate for Payer: Humana Commercial |
$72,055.35
|
| Rate for Payer: Humana KY Medicaid |
$29,152.75
|
| Rate for Payer: Kentucky WC Medicaid |
$29,449.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,512.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,561.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,431.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,737.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,598.48
|
| Rate for Payer: Ohio Health Group HMO |
$63,578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,816.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,750.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,491.99
|
| Rate for Payer: PHCS Commercial |
$81,380.16
|
| Rate for Payer: United Healthcare All Payer |
$74,598.48
|
|
|
PRECISION NERVE PULSE GEN KIT
|
Facility
|
IP
|
$84,771.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,431.30 |
| Max. Negotiated Rate |
$81,380.16 |
| Rate for Payer: Aetna Commercial |
$65,273.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,121.38
|
| Rate for Payer: Cash Price |
$42,385.50
|
| Rate for Payer: Cigna Commercial |
$70,359.93
|
| Rate for Payer: First Health Commercial |
$80,532.45
|
| Rate for Payer: Humana Commercial |
$72,055.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,512.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,561.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,431.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,598.48
|
| Rate for Payer: Ohio Health Group HMO |
$63,578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,816.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,750.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,491.99
|
| Rate for Payer: PHCS Commercial |
$81,380.16
|
| Rate for Payer: United Healthcare All Payer |
$74,598.48
|
|
|
PRECISION PT PROGRAMMER KIT
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
PRECISION PT PROGRAMMER KIT
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
PRECOSE (ACARBOSE) 25MG TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 23155014701
|
| Hospital Charge Code |
25001211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| 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 |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
PRECOSE (ACARBOSE) 5 50MG/1TAB
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 64380075906
|
| Hospital Charge Code |
25001212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
