|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
761T2437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
761P2437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,061.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.26
|
| Rate for Payer: Anthem Medicaid |
$566.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,035.79
|
| Rate for Payer: Healthspan PPO |
$941.22
|
| Rate for Payer: Humana Medicaid |
$566.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$378.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$577.45
|
| Rate for Payer: Molina Healthcare Passport |
$566.13
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$571.79
|
|
|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Professional
|
Both
|
$4,533.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
76102437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$4,533.00 |
| Rate for Payer: Aetna Commercial |
$1,061.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.26
|
| Rate for Payer: Anthem Medicaid |
$566.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,533.00
|
| Rate for Payer: Cash Price |
$2,266.50
|
| Rate for Payer: Cash Price |
$2,266.50
|
| Rate for Payer: Cigna Commercial |
$1,035.79
|
| Rate for Payer: Healthspan PPO |
$941.22
|
| Rate for Payer: Humana Medicaid |
$566.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$378.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$577.45
|
| Rate for Payer: Molina Healthcare Passport |
$566.13
|
| Rate for Payer: Multiplan PHCS |
$2,719.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,173.10
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$571.79
|
|
|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Facility
|
IP
|
$4,533.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
76102437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.29 |
| Max. Negotiated Rate |
$4,351.68 |
| Rate for Payer: Aetna Commercial |
$3,490.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,535.74
|
| Rate for Payer: Cash Price |
$2,266.50
|
| Rate for Payer: Cigna Commercial |
$3,762.39
|
| Rate for Payer: First Health Commercial |
$4,306.35
|
| Rate for Payer: Humana Commercial |
$3,853.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,345.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.23
|
| Rate for Payer: PHCS Commercial |
$4,351.68
|
| Rate for Payer: United Healthcare All Payer |
$3,989.04
|
|
|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
76102437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.29 |
| Max. Negotiated Rate |
$4,351.68 |
| Rate for Payer: Aetna Commercial |
$3,490.41
|
| Rate for Payer: Anthem Medicaid |
$1,558.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,535.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$2,266.50
|
| Rate for Payer: Cash Price |
$2,266.50
|
| Rate for Payer: Cigna Commercial |
$3,762.39
|
| Rate for Payer: First Health Commercial |
$4,306.35
|
| Rate for Payer: Humana Commercial |
$3,853.05
|
| Rate for Payer: Humana KY Medicaid |
$1,558.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,345.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,590.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.23
|
| Rate for Payer: PHCS Commercial |
$4,351.68
|
| Rate for Payer: United Healthcare All Payer |
$3,989.04
|
|
|
LABYRINTHOTOMY W/OR W/O CRYOSU
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69801
|
| Hospital Charge Code |
761T2437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
LAC-HYDRIN(AMMONIUM LACT 225GM
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 904598426
|
| Hospital Charge Code |
25000827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Anthem Medicaid |
$0.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.09
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna Commercial |
$2.22
|
| Rate for Payer: First Health Commercial |
$2.55
|
| Rate for Payer: Humana Commercial |
$2.28
|
| Rate for Payer: Humana KY Medicaid |
$0.92
|
| Rate for Payer: Kentucky WC Medicaid |
$0.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.83
|
| Rate for Payer: PHCS Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Payer |
$2.36
|
|
|
LAC-HYDRIN(AMMONIUM LACT 225GM
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 904598426
|
| Hospital Charge Code |
25000827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.09
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna Commercial |
$2.22
|
| Rate for Payer: First Health Commercial |
$2.55
|
| Rate for Payer: Humana Commercial |
$2.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.83
|
| Rate for Payer: PHCS Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Payer |
$2.36
|
|
|
LACOSAMIDE 50mg/5mL ORAL SOL'N
|
Facility
|
OP
|
$62.23
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna Commercial |
$47.92
|
| Rate for Payer: Anthem Medicaid |
$21.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.54
|
| Rate for Payer: Cash Price |
$31.11
|
| Rate for Payer: Cigna Commercial |
$51.65
|
| Rate for Payer: First Health Commercial |
$59.12
|
| Rate for Payer: Humana Commercial |
$52.90
|
| Rate for Payer: Humana KY Medicaid |
$21.40
|
| Rate for Payer: Kentucky WC Medicaid |
$21.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.76
|
| Rate for Payer: Ohio Health Group HMO |
$46.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.29
|
| Rate for Payer: PHCS Commercial |
$59.74
|
| Rate for Payer: United Healthcare All Payer |
$54.76
|
|
|
LACOSAMIDE 50mg/5mL ORAL SOL'N
|
Facility
|
IP
|
$62.23
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna Commercial |
$47.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.54
|
| Rate for Payer: Cash Price |
$31.11
|
| Rate for Payer: Cigna Commercial |
$51.65
|
| Rate for Payer: First Health Commercial |
$59.12
|
| Rate for Payer: Humana Commercial |
$52.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.76
|
| Rate for Payer: Ohio Health Group HMO |
$46.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.29
|
| Rate for Payer: PHCS Commercial |
$59.74
|
| Rate for Payer: United Healthcare All Payer |
$54.76
|
|
|
LACOSAMIDE 50MG TABLET
|
Facility
|
IP
|
$60.43
|
|
|
Service Code
|
NDC 31722081260
|
| Hospital Charge Code |
25000828
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna Commercial |
$50.16
|
| Rate for Payer: First Health Commercial |
$57.41
|
| Rate for Payer: Humana Commercial |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.18
|
| Rate for Payer: Ohio Health Group HMO |
$45.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.73
|
| Rate for Payer: PHCS Commercial |
$58.01
|
| Rate for Payer: United Healthcare All Payer |
$53.18
|
|
|
LACOSAMIDE 50MG TABLET
|
Facility
|
OP
|
$60.43
|
|
|
Service Code
|
NDC 31722081260
|
| Hospital Charge Code |
25000828
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Anthem Medicaid |
$20.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna Commercial |
$50.16
|
| Rate for Payer: First Health Commercial |
$57.41
|
| Rate for Payer: Humana Commercial |
$51.37
|
| Rate for Payer: Humana KY Medicaid |
$20.78
|
| Rate for Payer: Kentucky WC Medicaid |
$20.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.18
|
| Rate for Payer: Ohio Health Group HMO |
$45.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.73
|
| Rate for Payer: PHCS Commercial |
$58.01
|
| Rate for Payer: United Healthcare All Payer |
$53.18
|
|
|
LACTAID ULTRA (LACTASE) TAB
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
NDC 77333043550
|
| Hospital Charge Code |
25000829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
|
|
LACTAID ULTRA (LACTASE) TAB
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
NDC 77333043550
|
| Hospital Charge Code |
25000829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
|
|
LACTATED RINGERS 1000 ML
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LACTATED RINGERS 1000 ML
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LACTATED RINGERS (FS) 1000ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem Medicaid |
$32.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Humana KY Medicaid |
$32.41
|
| Rate for Payer: Kentucky WC Medicaid |
$32.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
LACTATED RINGERS (FS) 1000ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
LACTATED RINGERS (FS) 500ML
|
Facility
|
OP
|
$112.25
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem Medicaid |
$38.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Humana KY Medicaid |
$38.60
|
| Rate for Payer: Kentucky WC Medicaid |
$39.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
LACTATED RINGERS (FS) 500ML
|
Facility
|
IP
|
$112.25
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25003152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
LACTATED RINGERS IRRIGA 3000ML
|
Facility
|
IP
|
$87.54
|
|
|
Service Code
|
NDC 990782808
|
| Hospital Charge Code |
25003154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$84.04 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.28
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$72.66
|
| Rate for Payer: First Health Commercial |
$83.16
|
| Rate for Payer: Humana Commercial |
$74.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.04
|
| Rate for Payer: Ohio Health Group HMO |
$65.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.14
|
| Rate for Payer: PHCS Commercial |
$84.04
|
| Rate for Payer: United Healthcare All Payer |
$77.04
|
|
|
LACTATED RINGERS IRRIGA 3000ML
|
Facility
|
OP
|
$87.54
|
|
|
Service Code
|
NDC 990782808
|
| Hospital Charge Code |
25003154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$84.04 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Anthem Medicaid |
$30.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.28
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$72.66
|
| Rate for Payer: First Health Commercial |
$83.16
|
| Rate for Payer: Humana Commercial |
$74.41
|
| Rate for Payer: Humana KY Medicaid |
$30.11
|
| Rate for Payer: Kentucky WC Medicaid |
$30.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.04
|
| Rate for Payer: Ohio Health Group HMO |
$65.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.14
|
| Rate for Payer: PHCS Commercial |
$84.04
|
| Rate for Payer: United Healthcare All Payer |
$77.04
|
|
|
LACTATE (LACTIC ACID)
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
CPT 83605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Anthem Medicaid |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.57
|
| Rate for Payer: Humana KY Medicaid |
$11.57
|
| Rate for Payer: Humana Medicare Advantage |
$11.57
|
| Rate for Payer: Kentucky WC Medicaid |
$11.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.80
|
|
|
LACTATE (LD) (LDH) ENZYME
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
LACTATE (LD) (LDH) ENZYME
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$6.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$6.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Kentucky WC Medicaid |
$6.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
