|
LACTIC ACID VENOUS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
30000434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.57
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| 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: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.31
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
LACTIC ACID VENOUS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
30000434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.31
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
LACTULOSE ENEMA SOL 1000ML
|
Facility
|
OP
|
$33.38
|
|
|
Service Code
|
NDC 121087316
|
| Hospital Charge Code |
25003155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Anthem Medicaid |
$11.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.04
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna Commercial |
$27.71
|
| Rate for Payer: First Health Commercial |
$31.71
|
| Rate for Payer: Humana Commercial |
$28.37
|
| Rate for Payer: Humana KY Medicaid |
$11.48
|
| Rate for Payer: Kentucky WC Medicaid |
$11.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.37
|
| Rate for Payer: Ohio Health Group HMO |
$25.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.35
|
| Rate for Payer: PHCS Commercial |
$32.04
|
| Rate for Payer: United Healthcare All Payer |
$29.37
|
|
|
LACTULOSE ENEMA SOL 1000ML
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
NDC 121087316
|
| Hospital Charge Code |
25003155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.04
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna Commercial |
$27.71
|
| Rate for Payer: First Health Commercial |
$31.71
|
| Rate for Payer: Humana Commercial |
$28.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.37
|
| Rate for Payer: Ohio Health Group HMO |
$25.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.35
|
| Rate for Payer: PHCS Commercial |
$32.04
|
| Rate for Payer: United Healthcare All Payer |
$29.37
|
|
|
LAG SCREWS 4.0*40.0MM
|
Facility
|
OP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
LAG SCREWS 4.0*40.0MM
|
Facility
|
IP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
LAG SCREWS 4.0*45.0MM
|
Facility
|
IP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
LAG SCREWS 4.0*45.0MM
|
Facility
|
OP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
LAMBS QUARTERS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
LAMBS QUARTERS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
LAMICTAL (LAMOTRIGINE)100 MG T
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 904700861
|
| Hospital Charge Code |
25000831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
LAMICTAL (LAMOTRIGINE)100 MG T
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 904700861
|
| Hospital Charge Code |
25000831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
LAMICTAL (LAMOTRIGINE) 25 MG T
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 68084031801
|
| Hospital Charge Code |
25000830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| 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 |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
| Rate for Payer: Aetna Commercial |
$3.38
|
| 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 |
$4.17
|
|
|
LAMICTAL (LAMOTRIGINE) 25 MG T
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 68084031801
|
| Hospital Charge Code |
25000830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| 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 |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| 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 |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
LAMICTAL (LAMOTRIGINE) 5MG TAB
|
Facility
|
IP
|
$26.24
|
|
|
Service Code
|
NDC 173052600
|
| Hospital Charge Code |
25003849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.47
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Cigna Commercial |
$21.78
|
| Rate for Payer: First Health Commercial |
$24.93
|
| Rate for Payer: Humana Commercial |
$22.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.09
|
| Rate for Payer: Ohio Health Group HMO |
$19.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.13
|
| Rate for Payer: PHCS Commercial |
$25.19
|
| Rate for Payer: United Healthcare All Payer |
$23.09
|
|
|
LAMICTAL (LAMOTRIGINE) 5MG TAB
|
Facility
|
OP
|
$26.24
|
|
|
Service Code
|
NDC 173052600
|
| Hospital Charge Code |
25003849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Anthem Medicaid |
$9.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.47
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Cigna Commercial |
$21.78
|
| Rate for Payer: First Health Commercial |
$24.93
|
| Rate for Payer: Humana Commercial |
$22.30
|
| Rate for Payer: Humana KY Medicaid |
$9.02
|
| Rate for Payer: Kentucky WC Medicaid |
$9.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.09
|
| Rate for Payer: Ohio Health Group HMO |
$19.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.13
|
| Rate for Payer: PHCS Commercial |
$25.19
|
| Rate for Payer: United Healthcare All Payer |
$23.09
|
|
|
LAMISIL (TERBINAFINE H)1%/30GM
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 24385052405
|
| Hospital Charge Code |
25000836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Anthem Medicaid |
$0.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna Commercial |
$0.25
|
| Rate for Payer: First Health Commercial |
$0.29
|
| Rate for Payer: Humana Commercial |
$0.26
|
| Rate for Payer: Humana KY Medicaid |
$0.10
|
| Rate for Payer: Kentucky WC Medicaid |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.26
|
| Rate for Payer: Ohio Health Group HMO |
$0.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.09
|
| Rate for Payer: PHCS Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Payer |
$0.26
|
|
|
LAMISIL (TERBINAFINE H)1%/30GM
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 24385052405
|
| Hospital Charge Code |
25000836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna Commercial |
$0.25
|
| Rate for Payer: First Health Commercial |
$0.29
|
| Rate for Payer: Humana Commercial |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.26
|
| Rate for Payer: Ohio Health Group HMO |
$0.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.09
|
| Rate for Payer: PHCS Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Payer |
$0.26
|
|
|
LAMISIL (TERBINAFINE HCL)250MG
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 51991052601
|
| Hospital Charge Code |
25000837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
LAMISIL (TERBINAFINE HCL)250MG
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 51991052601
|
| Hospital Charge Code |
25000837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
LANGSTON CATH 6FR
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem Medicaid |
$692.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Humana KY Medicaid |
$692.96
|
| Rate for Payer: Kentucky WC Medicaid |
$700.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
LANGSTON CATH 6FR
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
LANOXIN (DIGOXIN) O .25MG/5ML
|
Facility
|
IP
|
$11.33
|
|
|
Service Code
|
NDC 17856005701
|
| Hospital Charge Code |
25000839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
LANOXIN (DIGOXIN) O .25MG/5ML
|
Facility
|
OP
|
$11.33
|
|
|
Service Code
|
NDC 17856005701
|
| Hospital Charge Code |
25000839
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem Medicaid |
$3.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Humana KY Medicaid |
$3.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
LANTERN MICROCATHETER 135 ST.
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
